Post by xyz3800 on Feb 27, 2024 22:10:09 GMT -8
The operator is not obliged to provide an individual health plan if it only works with collectives. This was the understanding reached by Minister Isabel Gallotti, of the Superior Court of Justice, when reforming the decision that forced the provision of an individual plan to a consumer, even though she only worked in the group plan segment. reproduction According to Minister Isabel Gallotti, the STJ has already stated that it is not illegal for health plan operators to refuse to sell individual plans because they only operate in the group plan segment. In the decision, the minister states that the original ruling diverged from the guidance already established by the STJ. "The STJ has already stated that it is not illegal for health plan operators to refuse to sell individual plans because they only operate in the collective plan segment.
There is no legal rule obliging them to operate in a specific branch of health plan", he says . According to the minister, coverage of care in cases of emergency or urgency is mandatory. "On the other hand, the health plan operator cannot be obliged to offer an individual plan to a former employee dismissed or dismissed without just cause after the right to temporarily stay in the collective plan has been exhausted, especially if it does not Exit Mobile Number List make this available on the market. type of plan, which cannot be equated with the cancellation of the private health care plan made by the employer itself, an occasion in which migration institutes or the portability of needs may be affected", he explains. According to the Law According to Fabíola Meira , partner at Braga Nascimento and Zilio Advogados, the STJ's decision, although it may cause surprise due to the difficulty that many consumers face in contracting an individual health plan, is in line with the law.
The obligation is that they sell a health care reference plan, that is, 'with medical-outpatient and hospital care coverage, including births and treatments, carried out exclusively in Brazil, with the standard of infirmary, intensive care center, or similar, when hospital admission is necessary, for diseases listed in the International Statistical Classification of Diseases and Related Health Problems, of the World Health Organization, in accordance with minimum requirements and exceptions provided for in the law itself", explains Fabíola.Irregularities The irregularities, according to the MPF, began in, when concessionaires started paying bribes to maintain the "good will" of the government and public agents in managing the concessions. This scheme was identified in the investigations of operation Integração, launched as part of the "lava-jato" operation, which investigates crimes of corruption, money laundering, tax evasion, embezzlement and embezzlement in the administration of federal highways in Paraná.
There is no legal rule obliging them to operate in a specific branch of health plan", he says . According to the minister, coverage of care in cases of emergency or urgency is mandatory. "On the other hand, the health plan operator cannot be obliged to offer an individual plan to a former employee dismissed or dismissed without just cause after the right to temporarily stay in the collective plan has been exhausted, especially if it does not Exit Mobile Number List make this available on the market. type of plan, which cannot be equated with the cancellation of the private health care plan made by the employer itself, an occasion in which migration institutes or the portability of needs may be affected", he explains. According to the Law According to Fabíola Meira , partner at Braga Nascimento and Zilio Advogados, the STJ's decision, although it may cause surprise due to the difficulty that many consumers face in contracting an individual health plan, is in line with the law.
The obligation is that they sell a health care reference plan, that is, 'with medical-outpatient and hospital care coverage, including births and treatments, carried out exclusively in Brazil, with the standard of infirmary, intensive care center, or similar, when hospital admission is necessary, for diseases listed in the International Statistical Classification of Diseases and Related Health Problems, of the World Health Organization, in accordance with minimum requirements and exceptions provided for in the law itself", explains Fabíola.Irregularities The irregularities, according to the MPF, began in, when concessionaires started paying bribes to maintain the "good will" of the government and public agents in managing the concessions. This scheme was identified in the investigations of operation Integração, launched as part of the "lava-jato" operation, which investigates crimes of corruption, money laundering, tax evasion, embezzlement and embezzlement in the administration of federal highways in Paraná.