{"id":6983,"date":"2024-09-04T09:00:00","date_gmt":"2024-09-04T12:00:00","guid":{"rendered":"https:\/\/bvp.letsite.com.br\/?p=6983"},"modified":"2024-09-04T09:00:00","modified_gmt":"2024-09-04T12:00:00","slug":"lei-plano-saude","status":"publish","type":"post","link":"https:\/\/bvp.adv.br\/en\/lei-plano-saude\/","title":{"rendered":"Altera\u00e7\u00e3o de lei determina cobertura pelo plano de sa\u00fade de tratamentos n\u00e3o inclu\u00eddos no Rol da ANS"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><em>por Thalita Oliveira Belber e Gabriela de Almeida Hilsdorf Dias<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As operadoras de planos de sa\u00fade est\u00e3o obrigadas a financiar tratamentos que n\u00e3o estiverem na lista mantida pela Ag\u00eancia Nacional de Sa\u00fade Suplementar (ANS), o chamado \u201crol taxativo\u201d.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A determina\u00e7\u00e3o est\u00e1 na lei n\u00ba 14.454\/2022, que foi sancionada pelo Presidente da Rep\u00fablica, a qual altera a Lei n\u00ba 9.656, de 3 de junho de 1998, que trata dos planos privados de assist\u00eancia \u00e0 sa\u00fade.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Segundo a ANS, o rol de procedimentos e eventos em sa\u00fade consiste em uma lista, aprovada por meio de Resolu\u00e7\u00e3o da Ag\u00eancia, em que s\u00e3o elencados os procedimentos, exames e tratamentos com cobertura obrigat\u00f3ria pelos planos de sa\u00fade, conforme a segmenta\u00e7\u00e3o assistencial do plano.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Essa lista \u00e9 atualizada periodicamente e serve como refer\u00eancia b\u00e1sica para a assist\u00eancia prestada pelos planos de sa\u00fade suplementar, detalhando os procedimentos e tratamentos que obrigatoriamente deveriam ser oferecidos, e que, at\u00e9 o momento, deixava a crit\u00e9rio dos planos de sa\u00fade a concess\u00e3o de exames e tratamentos que n\u00e3o estavam na lista.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Assim, em muitas situa\u00e7\u00f5es o tratamento de procedimentos que estivesse fora da lista da ANS acabava sendo decidido pelo Poder Judici\u00e1rio.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Nesse sentido, o Superior Tribunal de Justi\u00e7a (STJ) entendeu que esse rol, em regra, seria taxativo, e que, portanto, as operadoras de sa\u00fade n\u00e3o estariam obrigadas a cobrir tratamentos n\u00e3o previstos na lista, o que poderia causar a descontinuidade de tratamentos j\u00e1 obtidos pelos benefici\u00e1rios, especialmente \u00e0queles que s\u00e3o portadores de doen\u00e7as raras ou os casos em que o problema de sa\u00fade demandaria v\u00e1rias interven\u00e7\u00f5es m\u00e9dicas.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">No entanto, com a mudan\u00e7a da legisla\u00e7\u00e3o, agora a norma determina que o Rol de Procedimentos e Eventos em Sa\u00fade (Reps) ser\u00e1 apenas a \u201crefer\u00eancia b\u00e1sica\u201d para a cobertura dos planos de sa\u00fade, estando as operadoras obrigadas a fazerem os tratamentos ou procedimentos que n\u00e3o estejam previstos no rol, desde que cumpridas as seguintes condi\u00e7\u00f5es: tenha efic\u00e1cia comprovada cientificamente; seja recomendado pela Comiss\u00e3o Nacional de Incorpora\u00e7\u00e3o de Tecnologias no Sistema \u00danico de Sa\u00fade (Conitec), ou seja recomendado por pelo menos um \u00f3rg\u00e3o de avalia\u00e7\u00e3o de tecnologias em sa\u00fade com renome internacional, conforme especificado no art. 10\u00b0, par\u00e1grafo 13, inciso I e II, da lei 9.656\/1998.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Al\u00e9m disso, a Sumula 102 do Tribunal de Justi\u00e7a de S\u00e3o Paulo estabelece que, havendo expressa indica\u00e7\u00e3o m\u00e9dica, a negativa do plano para cobertura do tratamento m\u00e9dico sob o argumento de natureza experimental ou sobre a falta de previs\u00e3o no rol da ANS \u00e9 abusiva, veja-se:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>\u201cS\u00famula 102: Havendo expressa indica\u00e7\u00e3o m\u00e9dica, \u00e9 abusiva a negativa de cobertura de custeio de tratamento sob o argumento da sua natureza experimental ou por n\u00e3o estar previsto no rol de procedimentos da ANS.\u201d<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Outra modifica\u00e7\u00e3o importante feita na lei determina que as pessoas jur\u00eddicas de direito privado que operam planos de assist\u00eancia \u00e0 sa\u00fade tamb\u00e9m estar\u00e3o submetidas ao C\u00f3digo de Defesa do Consumidor.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Segundo o Minist\u00e9rio da Sa\u00fade, cerca de 50 milh\u00f5es de pessoas contratam planos de sa\u00fade no Brasil. Assim, a san\u00e7\u00e3o visa garantir mais seguran\u00e7a a esses usu\u00e1rios.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Ademais, a ANS ressalta que o processo de revis\u00e3o do rol n\u00e3o ser\u00e1 alterado. Isso quer dizer que a ag\u00eancia continuar\u00e1 recebendo e analisando propostas de inclus\u00e3o de forma cont\u00ednua, com as incorpora\u00e7\u00f5es podendo acontecer a qualquer momento e com ampla participa\u00e7\u00e3o social.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Portanto, \u00e9 abusiva a negativa do plano de sa\u00fade em cobertura de tratamentos ou procedimentos que n\u00e3o est\u00e3o elencados no Rol da ANS pelos motivos elencados acima, sendo certo que, em caso de indica\u00e7\u00e3o m\u00e9dica, a operadora de sa\u00fade deve cobrir o tratamento ou procedimento ao benefici\u00e1rio do plano, de forma integral.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A partir de agora o Rol de Procedimentos e Eventos em Sa\u00fade ser\u00e1 uma \u201crefer\u00eancia b\u00e1sica\u201d para a cobertura dos planos de sa\u00fade. <\/p>\n","protected":false},"author":1,"featured_media":6985,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[22],"class_list":["post-6983","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigos"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - 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