Procedimentos e eventos em saúde da Agência Nacional de Saúde Suplementar (ANS): rol taxativo ou exemplificativo?

Abstract

The present work proposes to analyze whether the list of procedures and health events of the National Health Agency - ANS, which establishes the mandatory care coverage to be guaranteed in private health care plans, has an exhaustive or merely illustrative character. This list has gained relevance in view of the high number of lawsuits filed with the aim of guaranteeing coverage by health plans for procedures not described by the ANS as mandatory coverage. Arriving at the Superior Court of Justice - STJ, the cases received divergent treatments between the Third and Fourth Panels, generating a significant difference in jurisprudence. Subsequently, the Second Section formed a majority to establish a thesis that the role is, as a rule, exhaustive, but has some exceptions. In this scenario, the present research seeks to analyze the conflicting decisions of the STJ in order to conclude whether the list of ANS procedures is exhaustive or not. To achieve this objective, a documentary and bibliographic research is presented divided into chapters, which address the main arguments against and in favor of taxation, passing through the fundamental right to health, as well as the role of the National Health Agency in the national order. As a result, this work argues that the list of ANS procedures has a mitigated exhaustive nature, in accordance with what was established by the judgment of the Second Section.