President Jair Bolsonaro (PL) sanctioned this Wednesday (21) the bill that forces health plans to pay for treatments that are not within the basic reference list YEAR (Complementary National Health Agency), ending the so-called taxing role.

The bill was approved at the beginning of August in the Chamber of Deputies in reaction to decision of the STJ (Superior Court of Justice) who understood that operators are obliged to pay only for the 3,368 treatments that appear on the ANS list.

The text was also endorsed by Senate floor. It requires health plan operators to cover procedures that fall outside the agency’s relationship, as long as they are recognized by other agencies or there is scientific evidence.

Entities opposed to the project argue that with the measure, health plans will have more costs and the bill will be passed on to consumers. On the other hand, associations representing people with disabilities, autism and rare diseases defend the project.

In August, the DPU (Office of the Public Defender) told the STF (Federal Supreme Court) that the comprehensive role of health insurance coverage violates the fundamental precepts of the Constitution and threatens the lives of millions of people.

Understand what changes with the new law.

What does the new law say?

The text specifies that the treatment or act prescribed by a doctor or dentist which is not provided for in the ANS list must be authorized by the operator provided that:

• there is evidence of effectiveness, in the light of health sciences, based on scientific evidence and a therapeutic plan;
• or there is a recommendation from Conitec (National Commission for the Integration of Technologies in the Unified Health System);
• or there is a recommendation from at least one internationally recognized health technology assessment body, provided it is also accredited for its nationals.

The text changes the law that deals with health plans to determine that operators are subject to both the rule and the consumer protection law – today they are only subject to the plan law.

What is the exemplary role of the ANS?

When the idea that the list is exemplary prevails, the ANS list only serves as a “basic reference”, which provides for the treatments that all operators are required to cover.

Thus, the coverage can go beyond the list and include other acts, provided that they have been prescribed by doctors and that they have proven their justification and their effectiveness.

What is the tax role?

The comprehensive list, in turn, limits coverage for health plan operators to procedures on the ANS list, with no option to include other treatments.

What role should you adopt?

The text sanctioned this Wednesday (31) established the understanding that the role is exemplary.

The proposal was a reaction to an STJ ruling in June that exempted operators from paying for procedures not included in the list.