Post by account_disabled on Jan 31, 2024 3:55:18 GMT -5
Trying to have a child is as much a part of family planning as contraceptive treatments. Thus, since Law 9,656/98 expressly provides that health plans are obliged to cover care in cases of family planning, it is up to the plans to also pay for in vitro fertilization treatments . For this, it does not matter that the treatment is not provided for in the contract with the insured person, or that it is outside the list of procedures provided for in a normative resolution from the National Supplementary Health Agency (ANS). Following this understanding, judge Josaphá Francisco dos Santos, from the Federal District Court of Justice, forced a health plan to pay for in vitro fertilization procedures for a couple with infertility.
The couple went to court after the health plan Buy Phone Number List refused to pay for the treatment. In the first instance, the request for early relief was denied. Represented by lawyer Nathália Monici , from Roberto Caldas, Mauro Menezes & Advogados, the couple appealed to the TJ-DF, which granted the injunction. In his decision, Josaphá dos Santos granted the request for urgent protection by recognizing the immediate need to begin treatment. The judge noted that the contract signed between the parties, based on an ANS resolution, specifically provides for the exclusion of coverage for infertility treatment.
However, he explained that article 35-C of Law 9,656 / 98 expressly provides that coverage of care is mandatory in cases of family planning. "Now, if Law 9,656/98 establishes coverage for family planning as mandatory and this, in turn, derives from a law that regulates constitutional provision and includes as one of the forms of planning the use of conception techniques, there is no way the exclusion imposed by ANS normative resolution prevail", he concluded. The judge also considered that the urgency of the measure is necessary given the wife's advanced age (35 years), which could worsen the disease and make the couple's infertility permanent.
The couple went to court after the health plan Buy Phone Number List refused to pay for the treatment. In the first instance, the request for early relief was denied. Represented by lawyer Nathália Monici , from Roberto Caldas, Mauro Menezes & Advogados, the couple appealed to the TJ-DF, which granted the injunction. In his decision, Josaphá dos Santos granted the request for urgent protection by recognizing the immediate need to begin treatment. The judge noted that the contract signed between the parties, based on an ANS resolution, specifically provides for the exclusion of coverage for infertility treatment.
However, he explained that article 35-C of Law 9,656 / 98 expressly provides that coverage of care is mandatory in cases of family planning. "Now, if Law 9,656/98 establishes coverage for family planning as mandatory and this, in turn, derives from a law that regulates constitutional provision and includes as one of the forms of planning the use of conception techniques, there is no way the exclusion imposed by ANS normative resolution prevail", he concluded. The judge also considered that the urgency of the measure is necessary given the wife's advanced age (35 years), which could worsen the disease and make the couple's infertility permanent.
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