Co-participation in hospitalization that exceeds 30 days is not abusive

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It is up to the insured to pay a co-payment to the health plan for psychiatric hospitalizations that exceed 30 days. This was understood by Minister Marco Aurélio Bellizze, of the Superior Court of Justice, when accepting the appeal and declaring the legality of the contractual clause that provides for the payment of co-participation. STJ STJ Bellizze reaffirmed the STJ's jurisprudence in the sense that the clause that provides for co-participation is not abusive in cases of hospitalization of more than 30 days In the action, the woman asks the health plan operator to pay for all mental treatment without a time limit.

After having her request denied in the first instance, the Iran Telegram Number Data author appealed to the 2nd Chamber of Private Law of the Court of Justice of São Paulo, which determined that the plan fully pays for the hospitalization. In its appeal to the STJ, the operator upheld the legality of the contractual clause in cases such as the one analyzed. In a monocratic decision, published this Thursday (25/4), the minister pointed out the understanding reached in the court that the co-participation clause is not abusive as long as it is contracted and informed to the consumer.



According to jurisprudence, stated the rapporteur, the measure is aimed at "maintaining the balance between the benefits and considerations that involve the management of the costs of health plan contracts". For example, the principles of transparency, free access, purpose and necessity must be observed, even if all amendments (or none) are approved by the National Congress. Furthermore, none of the amendments substantially changes the legal bases provided for the processing of personal data and the hypotheses authorizing the international transfer of such data.