Trabalho Plano de saúde

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Palavras-Chave: Plano de Saúde. ANS. Lei nº 9.656/98.CDC.CONSU

ABSTRACT[pic 8]

This study aims to develop doctrinal research, aiming to show how the advent of Law 9.656/1998 brought about evolution regarding the regulation of supplementary health in Brazil, specifically in relation to the regulation of private health plan operators. The procedure method was the bibliographical literature research on the topic under study, considering the necessary revision of the specialized literature, covering the main topics on the delimited question that, in the case of this study, covers the legal and doctrinal content regarding the Guidelines established since the advent of Law nº. 9.656/1998 on the regulation of health plans in the private sphere, whose analysis of bibliographic data was performed using the qualitative approach, using reference authors such as Luiz Henrique Sormani Barbugiani, with the book "Health Plans: Doctrine, Jurisprudence and Legislation", which sets out the origin of health insurance plans and insurance contracts, as well as the specific rights of users of health insurance plans and insurance; Josiane Araújo Gomes - "Health Plans Contracts", in which the author deals with the judicial search for the balance of interests between the users and the health plan operators, as well as regarding the specific legislations on health plans. It is concluded that in several decisions of relevance of the STJ, numerous situations of denials of health plan operators under the most diverse arguments that, after all, aim only to preserve the eagerness for greater profits by the operators and in which the Power Judiciary has almost always interfered in favor of the user, the purchaser and beneficiary of the health plan, who is obliged to seek in justice the rights guaranteed to them by the Federal Constitution of 1988, as well as by the Code of Consumer Protection.

Keywords: Health Plan. ANS. Law n. 9.656/98.

LISTA DE SIGLAS [pic 9]

ANS

Agência Nacional de Saúde

CDC

Código de Defesa do Consumidor

CONSU

Conselho Nacional de Saúde Suplementar

OMS

Organização Mundial da Saúde

RDCs

Resoluções da Diretoria Colegiada

RNs

Resoluções Normativas

ROs

Resoluções Operacionais

SUS

Sistema Único de Saúde

SUSEP

Superintendência de Seguros Privados

STJ

Superior Tribunal de Justiça

UNIMED

União dos Médicos

UTI

Unidade de Tratamento Intensivo

SUMÁRIO[pic 10]

1

INTRODUÇÃO....................................................................................................

10

2

EVOLUÇÃO DA SAÚDE SUPLEMENTAR NO BRASIL...................................

12

2.1

SURGIMENTO DO SETOR PRIVADO DE SAÚDE............................................

12

2.2

NORMATIZAÇÃO DO SETOR PRIVADO...........................................................

15

2.3

ENTIDADES REGULADORAS DE SAÚDE SUPLEMENTAR............................

16

2.3.1

A Regulação de Preços dos Planos de Saúde

20

2.3.2

Fiscalização e efetividade da regulação

21

3

REGULAÇÃO DA SAÚDE SUPLEMENTAR – LEI Nº 9.656/1998....................

23

3.1

SUJEITOS E OBJETOS REGULADOS PELA LEI..............................................

25

3.2

FORMAS DE CONTRATAÇÃO...........................................................................

26

3.3

TIPOS DE CONTRATOS DE PLANOS DE SAÚDE...........................................

27

4

OS CONTRATOS DE ASSISTÊNCIA PRIVADA À SAÚDE E O CÓDIGO DE DEFESA DO CONSUMIDOR .............................................................................

29

4.1

OS CONTRATOS DE PLANOS DE SAÚDE.......................................................

34

4.1.1

Direito à informação na relação contratual.....................................................

35

4.1.2

Coberturas..........................................................................................................