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Master's Dissertation
DOI
https://doi.org/10.11606/D.2.2020.tde-05052021-001705
Document
Author
Full name
Joana Indjaian Cruz
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2020
Supervisor
Committee
Aith, Fernando Mussa Abujamra (President)
Balbinot, Rachelle Amália Agostini
Bucci, Maria Paula Dallari
Scheffer, Mário César
Title in Portuguese
A regulação das coberturas na saúde suplementar e o direito à saúde
Keywords in Portuguese
Agências reguladoras -- Brasil
Cobertura de serviços privados de saúde -- Brasil
Conflitos de lei -- Brasil
Direito à saúde -- Brasil
Direito do consumidor -- Brasil
Saúde suplementar -- Brasil
Abstract in Portuguese
O trabalho investiga a regulação das coberturas na saúde suplementar no Brasil a partir de 1999, quando foi editado o marco regulatório do setor pela Lei n.º 9.656/1998, pela Lei n.º 9.961/2000 e a posterior normatização pela ANS (Agência Nacional de Saúde Suplementar). Por meio de pesquisa qualitativa e exploratória, identifica e descreve a legislação sobre regulação das coberturas na saúde suplementar; a atividade normatizadora da ANS sobre o tema; a doutrina sobre regulação das coberturas na saúde suplementar e a jurisprudência do STF (Supremo Tribunal Federal) e STJ (Superior Tribunal de Justiça) sobre coberturas na saúde suplementar. O direito à saúde e a regulação foram utilizados como referenciais teóricos. O trabalho conclui que há uma profusão de normas legais e infralegais que regulam as coberturas na saúde suplementar de forma diferente, apresentando conflitos normativos sobre a amplitude das coberturas. Também se conclui que a jurisprudência dos tribunais superiores reconheceu, em sua maioria, o direito às coberturas, com fundamento na Lei n.º 9.656/1998 e no Código de Defesa do Consumidor.
Title in English
The Regulation of Coverage in Supplementary Health and the Right to Health
Keywords in English
Health Insurance
Law
Regulation
Right to Health
Abstract in English
This work investigates the regulation of health insurance in Brazil from 1999, with the edition of the regulatory framework of the sector by Law No. 9,656 /1998, Law No. 9,961/2000 and subsequent normatization by NAHI (National Agency of Health Insurance). Through qualitative and exploratory research, this work identifies and describes the legislation on regulation of health insurance; NAHI's normative activity on the subject; the doctrine on regulation of supplementary health coverage and cases from National Supreme Court (NSC) and Superior Court of Justice (SCJ) on health insurance. The right to health and regulation were used as theoretical references. This work concludes that there is a profusion of legal and infralegal rules that regulate supplementary health coverage differently, presenting normative conflicts about the extent of the coverage. It also concludes that the jurisprudence of the higher courts mostly recognized the right to coverage of individuals, based on Law No. 9,656/1998 and the Consumer Protection Code.
 
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Release Date
2023-05-05
Publishing Date
2021-08-02
 
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