The Supreme Court (STJ) today (8) ruled that health plan operators are not required to pay for medical procedures not listed by the National Health Agency (ANS). There is an appeal against the decision.

By 6 votes to 3, the STJ denies that the agreements extend services to non-ANS procedures. Photo: Marcello Casal Jr/Agência Brasil/ND

The second section of the STJ understood that the list of procedures defined by the agency is exhaustive, that is, users are not eligible for examinations and treatments that are not included in the list.

By 6 votes to 3, the understanding of the rapporteur, Minister Luis Felipe Salomao, who had been voted on in previous sessions, prevailed.

In determining that the list is exhaustive, the minister understood that there would be an imbalance in health plan contracts if some users were awarded coverage in court that others were not. According to the minister, this will affect the economic balance of the complementary healthcare system and increase costs for all users.

The ANS List of Required Procedures and Treatments was compiled in 1998 to establish a minimum coverage that could not be denied by health insurance plans. The list has since been updated to include new technologies and advances.

Since then, users of health insurance plans have often sued for the right of operators to pay for procedures or treatments that are not already on the ANS list.