Senate approves bill against STJ’s decision determining that ANS’s list is exhaustive

Last Monday (August 29), the Brazilian Senate approved Bill No. 2033/2022 (“Bill”), which amends Law No. 9,656 of June 3, 1998 (“Health Care Plan Law”) in order to oblige health care plans to cover treatments and health examinations that are not in the list of procedures and events established by the Brazilian Supplementary Health Agency (“ANS”).

The Bill was submitted as a response to the decision issued in June of this year by the Brazilian Superior Court of Justice (STJ), which decided that the ANS list is exhaustive – that is, health plan operators would only be obliged to pay for procedures included in the ANS list. 

The Bill establishes that the ANS list will be a “basic reference” for private plans and other applicable contracts, given that it will set health care guidelines. Any treatment not in the list must also be covered, provided that it meets at least one of the following conditions:

(I) be scientifically proven to be effective;

(II) be recommended by the National Committee of Health Technology Incorporation (Conitec), in the Brazilian Unified Health System (SUS); or

(III) be recommended by at least one internationally renowned health technology assessment body.

In the latter case, the treatment must also be authorized for citizens residing in the country where the internationally renowned body is based, when applicable.

Finally, the Bill, which was submitted by the House of Representatives, was approved without amendments and unanimously supported by the Brazilian Senate. Now, the Bill is pending the presidential approval or veto.

Demarest’s Life Sciences team is monitoring the updates of the industry and is available to provide any further clarifications that may be necessary.