Operadoras terão que autorizar procedimentos com eficácia comprovada ou recomendados por organismos do setor
A Câmara dos Deputados deu uma resposta à altura das expectativas de usuários à manobra de legislar do Superior Tribunal de Justiça (STJ) e aprovou nesta quarta-feira (3) um projeto que obriga planos de saúde a cobrirem tratamentos e procedimentos fora do rol da Agência Nacional da Saúde (ANS).
O projeto derruba a restrição imposta por decisão do STJ, que entendeu como taxativa a lista de tratamentos que devem ser cobertos pelos planos de saúde.
Pela decisão do STJ, os planos ficaram desobrigados de cobrir procedimentos fora da lista que tem 3.368 itens.
A proposta aprovada nesta quarta diz que as operadoras deverão autorizar os planos de saúde a cobrirem tratamento ou procedimento prescrito por médico ou dentista que não estejam no rol da ANS, desde que haja um dos seguintes critérios:
- eficácia comprovada;
- recomendação da Comissão Nacional de Incorporação de Tecnologias no SUS ou;
- autorização da Agência Nacional de Vigilância Sanitária (Anvisa) ou;
- recomendação de, no mínimo, um órgão de avaliação de tecnologias em saúde que tenha renome internacional, desde que estes tenham aprovado o mesmo tratamento para seus cidadãos.
Entre as entidades de renome citadas no projeto estão: Food and Drug Administration, União Europeia da Saúde, Scottish Medicines Consortium (SMC); National Institute for Health and Care Excellence (Nice); Canada’s Drug and Health Technology Assessment (CADTH); Parmaceutical benefits scheme (PBS); e Medical Services Advisory Committee (MSAC).
“O marco legal dos planos de saúde trouxe segurança jurídica aos contratos de planos de saúde. Ocorre que se por um lado, passou a prever condições legais para a atividade de saúde suplementar, por outro discussões acerca da taxatividade ou exemplificação da lista permearam o judiciário”, diz a justificativa do projeto, de autoria de vários deputados.
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