Clipping of news on Brazilian Culture, Law and Citizenship
08.27.2015
This article was translated by an automatic translation system, and was therefore not reviewed by people.
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Beneficiary of Amil, a collective contract of adhesion, had canceled plan. Photo: Pablo Jacob / 06.05.2008
The technician Information Technology Jorge Eduardo de Lima, 40, was surprised the day before yesterday, to receive a written notice of cancellation of your health plan and the provision of other similar, with a three times greater value.
- The amount paid until this month was R$ 269.23. In the new billet I have received a similar plan, expiring on 10 September, they charged me R$ 613.66. A similar plan to me should have a value close - complained Lima, who hired the plane Amil Dix 100, about three years through Unifocus Administration Benefits.
According to the lawyer Renata Vilhena, plans cancellations in the collective agreements for membership have been frequent:
- The collective plan for accession is an undercover individual contract of collective level. The beneficiary must sign in with action and ask the judge to be treated as individual plan in order to prevent such unilateral termination.
In a survey by EXTRA on the site "Complain Here", five other similar cases were found, a Unifocus and four Qualicorp. All Just this August.
Attorney Camilla Salles, of Queiroz Andrade office, explains that according to Law 9,656 / 98, article 13, II, which regulates health plans, it is forbidden to unilateral termination of the provision of medical services contract. The only caveat is made with respect to the default for over 60 days or fraud.
- That is the only possible unilateral termination by the insurer if the consumer fails to make the monthly payment by more than 60 days since notified 30 days in advance, and in case of fraud. Such a forecast is for individual plans, however, due to the absence of specific legislation, applies this article also the corporate segment, mainly due to the legal certainty it brings to consumers and because the group plans currently are the ones that really move this market.
On the issue of abusive adjustment, Camilla explains that the Act provides that the adjustment should be according to the index established by ANS (National Health Agency), which this year was 9.65%.
- It should be clarified that the NSA establishes the adjustment percentage for individual plans and, by analogy, the Jusrisprudência apply the same percentage for the corporate segment or in the case of Judges less legalistic, they set a percentage slightly higher, around 12 to 15%, obviously within a reasonableness.
The National Health Agency (ANS) reported that the operator should notify to benefit manager on the cancellation of a contract with at least 60 days in advance. There is, however, a required period of notice to the beneficiary, but the NSA recommends that this be done immediately. Unifocus reported that the contract was canceled by Amil and the value of similar plan, reported to the customer, was wrong. He shall have another option for R$ 334.04, with dental plan included. Amil said in a statement that the changes in contracts managed by administrators are their responsibility and their contractors.
Source: Extra
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This article was translated by an automatic translation system, and was therefore not reviewed by people.