By Brazil Stock Guide – Brazil’s Supreme Federal Court (STF) ruled on Sept. 18 that health insurers must cover procedures outside the list maintained by the country’s health regulator ANS, but only if strict technical and legal criteria are met. The decision offers relief to operators such as Hapvida SA (B3: HAPV3), SulAmérica SA (B3: SULA11), Bradesco Saúde, Amil, and the Unimed system, which since 2022 have faced rising costs and mounting legal uncertainty.
Extra coverage will only be mandatory if prescribed by a qualified physician or dentist, when no alternative exists within the current list, with strong scientific evidence of efficacy and safety, registration at Anvisa, and no express denial or pending review by ANS. Judges must also verify that a prior request was made to the insurer, consult the Judiciary’s Technical Support Center (NATJUS), and notify the regulator if an injunction is granted.
“The STF didn’t close the door for patients, but it installed a latch that curbs unpredictability for insurers,” said a Brasília-based lawyer specializing in supplementary health.
What’s at stake
The ANS list has been non-exhaustive since Law 14,454/2022, passed after the Superior Court of Justice (STJ) had ruled it exhaustive. In practice, the law spurred litigation and squeezed insurers’ margins, as courts often granted coverage based solely on medical prescriptions. The STF’s ruling keeps the list open but adds technical and procedural brakes that balance patients’ rights with insurers’ sustainability.
Leave a Reply