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Court Decision Exposes Flaws In Business Contracts Sold To Families And Reinforces Limits Set By ANS For Annual Adjustments
The court confirmed, in October 2024, that a health plan marketed as business for a family of four actually operated as a family plan.
Therefore, it should comply with the annual limit of 6.06% set by ANS in May 2024.
The family contested the adjustments in court in 2022, arguing that the increases exceeded the percentages allowed for individual plans.
This situation has sparked a relevant discussion about contractual classifications and reinforced debates on consumer protection in health contracts.
Technical Analysis Reveals That The Contract Did Not Dilute Risks and Characterized A “False Collective”
The evaluation conducted by the São Paulo Court of Justice (TJSP) concluded that the contract did not have a structure compatible with a collective plan.
This occurred because there was not a sufficient number of beneficiaries to dilute risks, which is essential in this type of arrangement.
The court identified that the group had only four members of the same family.
This small number meant that any more expensive treatment could destabilize the cost.
This imbalance justified the high increases imposed by the operator.
This finding led the TJSP to order the refund of the amounts paid unduly, with monetary correction and interest.
Expert Highlights That Families Are Pushed Into Business Plans Due To Lack Of Alternatives In The Market
The lawyer Renata Mangueira de Souza, a civil procedure specialist at the Gasparini, Barbosa e Freire Advogados law firm, stated, in an analysis conducted in 2024, that this type of situation has become common.
According to her, many families end up opting for business plans because several operators no longer offer traditional family plans.
This lack of alternatives particularly affects small groups, such as couples or parents with children.
She emphasizes that this practice weakens consumers, exposing them to abusive adjustments and less legal protection.
Additionally, they are subject to abrupt cancellations, since rules for legal entities differ from those for individuals.
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STJ Upholds Understanding Of TJSP And Reinforces Limits For Review Of Facts In Higher Courts
The operator appealed to the Superior Court of Justice (STJ) and claimed that the contract was formally collective.
However, in July 2024, the STJ upheld the understanding of the TJSP.
The court stated that it is not appropriate to re-examine facts, as there are already consolidated decisions on similar cases.
These cases involve plans sold as business but formed only by family members.
This position reinforces that, without a group capable of diluting risk, the contract cannot be considered truly collective.
Therefore, the adjustments cannot exceed the limits set for family plans.
Legal Debate Highlights Direct Impact On Consumer Protection And Contract Compliance
The decision did not specify a number of members to consider a plan a “false collective”.
However, the understanding of the courts was clear in stating that, in this case, there was no structural basis for business classification.
This occurred because essential elements of collective risk were lacking.
Thus, it remains valid the determination that the family must receive the excess amounts paid.
This refund was confirmed because the adjustments were considered irregular.
This case highlights the growing challenge faced by consumers regarding forced migration to business plans and expands discussions on transparency, commercial practices, and compliance in the health sector.
What Does This Decision Represent For Consumers Facing Business Plans Sold To Families?
The case provokes an important reflection on how to protect families from abusive adjustments.
This occurs because business contracts continue to be used as a forced alternative for those who cannot find family plans.
In light of this, the central question arises for public debate.
What do you consider essential to avoid new cases of “false collectives”: greater oversight of operators, revision of hiring rules, or strengthening legal protection for consumers?
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