out of service
It is illegal for a health fund operator to unilaterally terminate a contract without clear justification in the contract.
Conditions for canceling a health plan contract must be clarified
Based on Standard Decision 195/2009, Judge Carlos Eduardo Batista dos Santos, of the Second Civil Court of Brasilia, decided that the operator maintains the plaintiff as a beneficiary of an individual health plan and pays her compensation for moral damages.
An 81-year-old woman's health insurance company unexpectedly canceled her health plan, without prior notice and without offering alternatives. The elderly woman has been a beneficiary of the plan since December 2013, when she joined the services en masse.
According to the decision, the patient has been undergoing medical treatment for breast cancer since 2009. After the termination was announced, Jadwa requested to maintain her quality on an individual basis with the operator, to no avail.
The company's defense argued that the termination of the contract was carried out in accordance with the terms of the agreement and the applicable legislation in this regard. Furthermore, the company claimed that the health plan was in effect from November 1, 2010 until October 31, 2023 and that it elected to terminate the contract at the end of the pre-specified validity period.
The decision notes that Resolution 195/2009 stipulates that the conditions for canceling a contract or suspending coverage in private group health care plans through group or institutional membership must be expressly included in the contract signed between the two parties.
The judge upheld the woman's application, affirming the effects of the previously granted emergency relief, in order to convict the health worker of maintaining his beneficiary status in the individual plans, with the same amount of the monthly fee he was already paying and subsequent adjustments according to the criteria determined annually by the National Agency for Supplementary Health (ANS).
The judge also considered that canceling the plan would result in moral damages and ordered the company to pay compensation for moral damages in the amount of 10,000 Brazilian reals.
Click here to read the decision
Process 0744743-79.2023.8.07.0001
