71% adjustment in health plan for elderly people is consider

Dołączył: 07 Mar 2024 Posty: 1

The criteria used by a health plan operator to make adjustments cannot result in excessive charges. This was the decision of the 1st Chamber of Private Law of the Court of Justice of São Paulo in a case in which an elderly woman saw the value of her plan's monthly fee increase from R$743 to R$1,271 (an increase of 71%) due to migration age group for 63 to 70 years. The defense recalled that the readjustments promoted by Sul América far exceeded those made by competitors.

The adjustments implemented in my client’s contract, which Iran Telegram Number Data dates back to 1995, were made unreasonably”, maintained lawyer Thaís Alonso. The defender also highlighted that the Federal Court of Auditors recently carried out an audit of the National Supplementary Health Agency (ANS) and found a series of inconsistencies in the individual adjustments applied. According to the appeal's rapporteur, judge Enéas Costa Garcia, the adjustments follow seven age groups, but use criteria that are not suitable for the consumer. “In the calculation there is an analysis of variation in hospital medical costs, which constitutes double billing”, understood the judge. The decision was unanimous.

The rapporteur also stated that the Federal Supreme Court also has precedents equating sales to ZFM with exports, understanding that the specific discussion regarding the possibility of these taxpayers using Reintegra would be an infraconstitutional matter, not recognizing the general repercussion of the matter in RE 102.3434/PR. Divergence overcome In this Tuesday's session, in a unanimous vote, Minister Benedito Gonçalves followed the divergence already opened by Minister Gurgel de Faria. "There are peculiarities of legislation. In the case of Reintegra, the legislator intended to show specific reasons, so that the decree could not be applied to extend rights," he said.

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