São Paulo courts rule against health insurance providers

The Court of Justice of São Paulo (TJ-SP) has issued two significant rulings regarding health insurance regulations and consumer rights in Brazil.

In one case, a judge recognized a “false collective” plan, where a corporate health insurance contract was held for only four members of the same family. The court ruled that such a small group lacks the necessary scale to dilute risks, effectively treating it as an individual or family plan. Consequently, annual price adjustments applied since 2017 based on medical cost variations were annulled and must be replaced by the maximum indices authorized by the National Health Agency (ANS).

In a separate ruling, the 4th Private Law Chamber of the TJ-SP determined that a health insurance provider cannot refuse to contract a patient due to a pre-existing condition. The court ordered the implementation of the plan with retroactive effects to February 2025 for an oncology patient. The provider had previously cited “commercial disinterest” without technical justification, which the court identified as a form of risk selection. The operator was also ordered to pay R$ 10,000 in moral damages.