Supreme Court of Justice (STJ) he discontinued all proceedings in the country who discussed health care and the cost terms of a collective health plan for beneficiariesespecially pensioners, Minister Antonio Carlos Ferreira emphasized that these conditions relate to the length of stay in the plan, whether for a fixed or indefinite period; social security rights that will be the responsibility of the former employee and his dependents; and financial costs to be borne by the former employee. No date has been set for the reasoning of the judgment.
According to law 9,656 / 1998 – Law on Health Plans – Guaranteed for Worker notice no reason or retirees. who contributed health plan, the right to maintain the plan of the company as a beneficiary, under the same conditions of coverage of assistance from active employees, provided that the full cost of compensation is assumed.
"The relevance of demand is beyond question. It should be noted the multiplication of collective health plans and the rise of processes involving this type of recruitment by companies, aimed at the peace and well-being of employees and their dependents, who must also be aware of what will actually happen after retirement or eventual dismissal, ”the minister said in the decision.
Controversy about the setting
What they do, for lawyers specializing in the right to health The STJ will discuss the amount the plan beneficiary will have to pay after retirement, Rafael Robba, a lawyer for Vilhena Silva, explains that, while working, the user contributes a fixed value plan based on the average cost calculated among all company employees. After retirement and retirement, however, health insurers place these beneficiaries in other age-adjusted plans, making private care more expensive.
– Usually older than 59 years. So, it goes into the retirement age range and undergoes a change in form of payment that affects older people too much. It already has a significant reduction in its benefits and still has a high health insurance price, which ultimately results in the elimination of benefits. So the question is whether he can pay toward the property or whether he will have to pay differently, "Robba said.
Rodrigo Araújo, of Araújo Conforti and Jonhsson, notes that the deviation occurred after the issuance of Normative Resolution 279 of the National Agency for Supplemental Health (ANS). According to him, the norm creates conditions for operators to implement conditions of adjustment to different ages for inactive, as opposed to active employees.
– In practice, the ANS mandates health planning for the conclusion of different contracts and the separation of contracts between active and inactive. But an inactive contract, in addition to adjusting by age, also has a higher loss ratio because it is used by older users. The debate is why the Plan Act does not make that distinction and the ANS administrative rule cannot invalidate the law – said Araújo.
The STJ's decision brings proceedings at first and second instance and to those pending in separate courts.
– At the Court of Justice of the European Union in São Paulo (TJ-SP), the majority understands that this different indictment is abusive and cannot create a different situation among users because it is even discriminatory. The law of plans does not speak of differentiated billing in inactive. What creates the conflict in justice is this differentiation, ”Robba said.
Conditions for maintaining the plan
– A retired, former employee fired or fired without just cause contributing to the cost of his or her private health plan is entitled to retain the same terms of assistance covering employment contracts without prejudice to any benefits gained. in collective bargaining.
– A retiree, laid-off former employee or laid-off employee must take full pay of the monthly plan benefit.
– An employer is required to retain a retiree, ex-employee, or layoff in the plan, while compensation is offered to active employees, provided the employee has contributed to the cost of his or her private health plan. not be admitted to a new job.
– The decision of a retiree, former employee or exempt to remain in the plan must be notified to the employer within 30 days of the employer’s notice of benefits.
– The right to use the plan must be extended to the family group that was registered when the employment contract was in force.
– In the event of the death of a retired, dismissed former employee or dismissed employee, his or her dependents will remain on the plan for the remainder of the time to which the beneficial owner is entitled.
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