Brazil courts rule on health insurance coverage and contract validity

The Superior Tribunal de Justiça (STJ) has ruled that health insurance providers cannot abruptly terminate coverage for multidisciplinary treatment for beneficiaries diagnosed with ADHD (TDAH), even during the unilateral rescission of a collective contract. According to the decision by the 3rd Chamber, coverage must be maintained until the patient achieves medical discharge, clinical stabilization, or successfully migrates to a new health plan.

In a separate matter, the Court of Justice of São Paulo (TJ/SP) invalidated a corporate health insurance contract involving only three family members, classifying it as a ‘false collective’ plan. The court ruled that the lack of insurance dispersion and bargaining power invalidated the corporate model, subsequently annulling non-transparent price increases and imposing ANS-established caps for family contracts.