Normative Resolution No. 465/2021
In February of this year, the National Supplementary Health Agency (ANS) approved Normative Resolution No. 465/2021, which updates the List of Procedures and Events in Health, whose effective date is 01/04/2021. Among the modifications, the provision of article 2 gained repercussion in the legal community, according to which “for the purposes of coverage, the list […] provided for in this Normative Resolution and its annexes” is considered to be exhaustive. This is because in the Superior Court of Justice (STJ) there is disagreement in the Private Law Classes regarding the nature of this role, that is, whether it is exhaustive or exemplary.
It is clarified, first, that ANS is the agency responsible for the regulation of the supplementary health sector, including in its competences the regulatory power, which covers, by legal determination, the elaboration of the list of procedures and events and health and the definition of the coverage range. This list is periodically updated in accordance with RN No. 439/2018, which establishes the administrative rite, highlighting, for example, the biannual cycles, the procedure guidelines, the eligibility requirements of the proposals and the participation of civil society .
RN No. 465/2021 provides, among other aspects, assistance exclusions applicable to all products of any segmentation; need for communication about changes in mandatory coverage, especially with regard to exclusions; specific exclusions in outpatient segmentation; and the indispensability of observing the contractual clauses.
The highlight of article 2 is the contribution to legal certainty, when the interpretation that can be given to the list is restricted, since it is expressly considered as exhaustive, in addition to maintaining the possibility for operators to offer greater coverage than the mandatory minimum. Thus, the limits of health procedures and events that comprise the mandatory minimum assistance coverage were verbatimly fixed. In the same sense, Article 17 delimits the coverage of assistance referred to in the reference plan to the content of the new resolution and its annexes, unlike Article 20 of RN No. 428/2017.
It is observed, then, that the regulation sought to eliminate ambiguities, clarify controversial points and, consequently, reduce the legal uncertainty to the interested parties. Furthermore, the incorporation of new health technologies was envisaged, covering procedures and medications.
Wilson Sales Belchior