Fenasps’ legal counsel issues memorandum on the court ruling of the Truth and Justice Commission that will decide mandatory coverage for health plans

Thursday 02/24/22

The Fenasps National Legal Advisory Board (AJN) issued a memorandum, this Thursday, February 24, regarding the ruling, in the Supreme Court of Justice (STJ), which will decide whether health plans will only be obligated to cover treatments provided for in the role of the National Agency for Complementary Health ( ANS).

The trial was tied 1-1, and was adjourned upon request for an offer (more time to analyze the matter) from Syrians Minister for Truth and Justice, Vilas Boas Cueva. There is still no set date for the trial, which should affect about 50 million users of health plans in the country, among whom hundreds of thousands of people with the help of GEAP Saúde and Capesesp (Capesade).

Read AJN’s note below:

We would like to inform you that this National Legal Advisory Section followed yesterday, 23, the resumption of the trial of ERESP cases 1886929 and 1889704, currently pending in Section II of the STJ – Supreme Court of Justice, which is dealing with it with a list of proceedings edited by the ANS – Agência Supplementary Health, more specifically for deciding whether this list is “tax” (for example, health plan operators are only required to provide the actions stipulated therein), or “model” (i.e. operators will be obligated to cover other actions, indicated by the physician and at a discretion My knowledge, even if it is not on the list).

The trial had begun last year with the vote of the Rapporteur, Minister Luis Felipe Salomao, who presented a position on the comprehensiveness of the list of actions, followed by the request for “opinions” by Minister Nancy Andregue, and resumed yesterday, when the Minister made a brilliant vote of the exemplary nature of the role of the ANS.

However, the trial was suspended due to a request for “opinions” from Minister Vilas Boas Cueva, with no date set for the trial to continue.

It is important to note that the second section of STJ consists, in addition to the aforementioned judges, of Justices Antonio Carlos Ferreira (President), Raúl Araujo, Paulo de Tarso Sanseverino, Marcos Buzzi, Marcos Aurelio Bellez and Mora. Ribeiro, as well as Minister Maria Isabel Gallotti.

Finally, it should be noted that from a procedural point of view, there is no way for FENASPS to interfere at the current procedural stage, such that any initiative of the Federation regarding the continuation of the trial in the policy field must be implemented.

On the other hand, it should be noted that today, February 24, FENASPS will present oral arguments, as court friends, in Pet. 12,482 people will be tried in the first section of Syrians for Truth and Justice.

This is a potential revision to Topic 692, of the Repeated Appeals System, which currently states: “A decision reform that anticipates guardianship obliges a plaintiff to return unjustified Social Security benefits.”

In other words, STJ’s current position is that Social Security funds received as a result of unstable judicial decisions (injunctions and advance orders), will be returned to the treasury if the measure is refused.

Thus, although referring directly to the benefits of social security, the well-established thesis also ends with a reflection on the values ​​that public officials are already aware of, as a result of unsettled judicial decisions, thus strengthening the interest of FENASPS, and the category, in determining them.

FENASPS National Legal Advice

Download here This note is in pdf format.