Post by sailasathay on Jan 10, 2024 6:38:08 GMT -5
Elderly beneficiaries who lose their dependent status, due to being excluded at the request of the holder after more than ten years of contribution, have the right to assume ownership of the collective health plan through membership, as long as they cover the respective costs.
Disclosure
Minister Nancy Andrighi, case rapporteur WhatsApp Number List Disclosure
With this understanding, the 3rd Panel of the Superior Court of Justice allowed a 70-year-old woman to maintain the collective health plan through membership, in which she appeared as a dependent of her ex-husband.
After the divorce, the author was excluded from the plan at the request of the plan holder, despite having already contributed for almost 20 years. The Mato Grosso Court of Justice had considered it possible to transfer ownership of the plan. According to the court, the exclusion of the elderly dependent would violate the principles of trust, contractual good faith and human dignity, as it would force her to take out a new health plan.
In an appeal to the STJ, the plan operator argued the impossibility of transferring ownership of the medical services to third parties and added that the elderly woman had no connection with the entity.
Minister Nancy Andrighi, rapporteur of the case, recognized that collective health plans require a link between the holder and the contracting legal entity, without which family membership is not permitted. Thus, if there is loss of the link or condition of dependence, the exclusion of the beneficiary is authorized.
However, the judge highlighted that, in this specific case, there was no break in the bond between the holder and the company, but rather the loss of the dependent status of the beneficiary due to the divorce.
Nancy recalled that Law 9,656/1998 brings about the need for differentiated and more careful treatment for elderly beneficiaries of private health care services. According to her, the rule expresses a concern about preserving the retiree's contract, "precisely considering their extreme dependence on the service and the notorious difficulty of new affiliation due to their age".
The rapporteur also highlighted that "this solution ensures health care for the elderly, without implying a change in the economic-financial balance of the contract, as there is only a transfer of ownership of the plan and the respective costs to those who already belonged to the group of beneficiaries". With information from the STJ press office .
Disclosure
Minister Nancy Andrighi, case rapporteur WhatsApp Number List Disclosure
With this understanding, the 3rd Panel of the Superior Court of Justice allowed a 70-year-old woman to maintain the collective health plan through membership, in which she appeared as a dependent of her ex-husband.
After the divorce, the author was excluded from the plan at the request of the plan holder, despite having already contributed for almost 20 years. The Mato Grosso Court of Justice had considered it possible to transfer ownership of the plan. According to the court, the exclusion of the elderly dependent would violate the principles of trust, contractual good faith and human dignity, as it would force her to take out a new health plan.
In an appeal to the STJ, the plan operator argued the impossibility of transferring ownership of the medical services to third parties and added that the elderly woman had no connection with the entity.
Minister Nancy Andrighi, rapporteur of the case, recognized that collective health plans require a link between the holder and the contracting legal entity, without which family membership is not permitted. Thus, if there is loss of the link or condition of dependence, the exclusion of the beneficiary is authorized.
However, the judge highlighted that, in this specific case, there was no break in the bond between the holder and the company, but rather the loss of the dependent status of the beneficiary due to the divorce.
Nancy recalled that Law 9,656/1998 brings about the need for differentiated and more careful treatment for elderly beneficiaries of private health care services. According to her, the rule expresses a concern about preserving the retiree's contract, "precisely considering their extreme dependence on the service and the notorious difficulty of new affiliation due to their age".
The rapporteur also highlighted that "this solution ensures health care for the elderly, without implying a change in the economic-financial balance of the contract, as there is only a transfer of ownership of the plan and the respective costs to those who already belonged to the group of beneficiaries". With information from the STJ press office .