Key Benefits:
PROVISIONAL MEASURE # 2.177-44, OF August 24, 2001
Alters Law No. 9,656, June 3 of 1998, which has on the private health assistance plans and gives other arrangements.
THE PRESIDENT OF THE REPUBLIC, in the use of the attribution that confers you the art. 62 of the Constitution, adopts the following Interim Measure, with force of law:
Art. 1º Law No. 9,656 of June 3, 1998, passes vigorously with the following changes:
" Art. 1º Submit to the provisions of this Act private legal persons who operate health assistance plans, without prejudice to compliance with the specific legislation governing their activity, adopting, for the purposes of implementing the standards here established, the following definitions:
I-Private Plan of Health Assistance: continued provision of services or cost coverage attendance at pre-or post-established price, by indeterminate term, for the purpose of ensuring, without financial limit, health care, by the faculty of access and care by professionals or health services, freely chosen, members or not of accredited, contracted or referenced network, targeting medical, hospital and dental care, to be paid full or partially at the expense of the contractor, upon reimbursement or direct payment to the provider, per account and order of the consumer ;
II-Health Assistance Plan Operator: legal person constituted under the modality of civil or commercial society, cooperative, or self-management entity, which operates product, service or contract of which it treats the inciso I of this article ;
III-Portfolio: the set of assisted-cost coverage contracts or of services of health assistance in any of the modalities of which they treat inciso I and § 1º of this article, with all the rights and obligations contained therein.
§ 1º It is subordinated to the standards and supervision of the National Supplemental Health Agency-ANS any product, service and contract modality that presents, in addition to the guarantee of financial coverage of medical, hospital and dental care risks, other characteristics that differentiate you from exclusively financial activity, such as:
a) cost of expenses ;
b) accredited or refereed network offering ;
c) reimbursement of expenses ;
d) mechanisms of regulation ;
e) any contractual, technical, or operational restriction for the coverage of procedures requested by consumer chosen prestator ; and
f) binding financial coverage to the application of concepts or criteria medical-assistential.
§ 2º Include in the scope of this Act the cooperatives that operate the products of which they treat the inciso I and § 1º of this article, as well as entities or companies that maintain health-care systems, by the modality of self-management or administration.
§ 3º Physical persons or legal persons residing or domiciled abroad may constitute or participate in the capital, or increase in capital, of legal persons of private law constituted under Brazilian laws to operate private health assistance plans.
§ 4º It is vetoed to the physical persons the operation of the products of which they treat inciso I and § 1º of this article. " (NR)
" Art. 8º To obtain the operating authorization, operators of private health care plans must meet the following requirements, regardless of whether others who come to be determined by ANS:
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§ 1º Are dispensed from the fulfilment of the conditions set forth in the incisos VI and VII of this article entities or companies that maintain private health care systems in the modality of self-management, cited in § 2º of the art. 1º.
§ 2º The operating authorization will be cancelled if the operator does not market the products of that treat the inciso I and the § 1º of the art. 1º of this Act, within the maximum period of one hundred and eighty days from your registration at the ANS.
§ 3º Private health care operators will be able to voluntarily apply for authorization for closure of your activities, observing the following requirements, regardless of others who come to be determined by ANS:
a) proof of the transfer of the portfolio without injury to the consumer, or the non-existence of beneficiaries under their responsibility ;
(b) guarantee of the continuity of the provision of services of the beneficiaries admitted or in treatment ;
c) proof of the discharge of its obligations to service providers within the scope of the operation of private plans for health care ;
d) prior information to the ANS, beneficiaries and contracted service providers, accredited or referenced, in the form and in the deadlines to be defined by the ANS. " (NR)
" Art. 9º After decorated one hundred and twenty days of this Act, for carriers, and two hundred and forty days, for the administrators of health care plans, and until they are defined by the ANS, the general standards of registration, the persons legal ones operating the products of which treat inciso I and § 1º of the art. 1º of this Act, and observed what art has. 19, will only be able to commercialize these products if:
I-the carriers and administrators are provisionally enrolled in the ANS ; and
II-the products to be marketed are registered at the ANS.
§ 1º The disfulfilment of the formalities provided for in this article, in addition to setting up infringement, constitutes aggravating in the application of penalties for infringing the other standards provided for in this Act.
§ 2º The ANS may request information, determine changes, and promote the suspension of the whole or part of the conditions of the submitted plans.
§ 3º The marketing authorization will be cancelled if the operator does not market the plans or the products of which treat the inciso I and § 1º of the art. 1º of this Act, within the maximum period of one hundred and eighty days from your registration at the ANS.
§ 4º ANS may determine the temporary suspension of the marketing of plan or product case identify any contractual, econome-financial or assistive irregularity. " (NR)
" Art. 10. The health care assistance-reference plant is hereby established, with medical and hospital assistive medical and hospital coverage, comprising parts and treatments, performed exclusively in Brazil, with standard of infirmary, intensive care centre, or similar, when necessary for hospital internation, of the diseases listed in the International Statistical Classification of Health Diseases and Problems Related to the World Health Organization, respected the minimum requirements laid down in the art. 12 of this Act, except:
I-clinical or surgical treatment or experimental surgical ;
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VII-provision of prostheses, ortheses and their accessories not linked to the surgical act ;
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§ 1º The constant exceptions of the incisions of this article will be the subject of regulation by the ANS.
§ 2º Legal persons who market products of which treat the inciso I and § 1º of the art. 1º of this Act will necessarily offer, as of December 3, 1999, the plant-reference that it treats this article to all of its current and future consumers.
§ 3º Excludes the obligation referred to in § 2º of this article legal persons who maintain health care systems for self-management modality and legal persons who exclusively operate dental plans.
§ 4º The breadth of toppings, including transplants and high complexity procedures, will be defined by standards edited by ANS. " (NR)
" Art. 11. The exclusion of cover for diseases and preexisting injury to the date of hiring of the products of which they treat the inciso I and § 1º of the art is vetoed. 1º of this Act after twenty-four months of the rent of the contractual instrument, with the respective operator the burden of proof and the demonstration of the prior knowledge of the consumer or beneficiary.
Single Paragraph. The suspension of consumer health assistance or beneficiary, holder or dependant is vetted, until proof that it treats the caputin the form of the regulation to be edited by the ANS. " (NR)
" Art. 12. They are provided with the offer, the hiring and the duration of the products of which they treat the inciso I and § 1º of the art. 1º of this Act, in the segmentations provided for in the incisos I to IV of this article, respected the respective coverage amplitudes set out in the plant-reference of which it treats art. 10, under the following minimum requirements:
I-....................................................................
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b) coverage of diagnostic support services, treatments and other ambulatory procedures, requested by the assistant doctor ;
II- .........................................................................................................................................
a) coverage of hospital internation, vegin with time limitation, maximum value and quantity, in basic and specialized clinics, recognized by the Federal Medical Council, by admitting to the exclusion of the obstetric procedures ;
b) coverage of hospital internations in intensive care center, or similar, vedded to limitation of time, maximum value and quantity, at the discretion of the assistant doctor ;
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d) coverage of complementary examinations indispensable for the control of the evolution of the disease and elucidation diagnostics, supply of medicinal products, anesthetics, medicinal gases, transfusions and chemotherapy and radiotherapy sessions, as prescribed by the assistant physician, carried out or delivered during the internation period hospital ;
e) coverage of any and any fee, including materials used, as well as the removal of the patient, demonstrably necessary, for another hospital establishment, within the limits of geographical scope provided for in the contract, in Brazilian territory ; and
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III ............................................................................................................................................................................................................................................................................................................................
b) enrolment assured to the newborn, natural child or consumer adoptive, as dependent, exempt from the fulfillment of the grace periods, provided that the inscription occurs within the maximum thirty days of the birth or adoption ;
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V- .........................................................................................................................................
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c) maximum period of twenty-four hours for the coverage of cases of urgency and emergency ;
VI-refund, in all types of products of which treat the inciso I and § 1º of the art. 1º of this Act, within the limits of contractual obligations, of the expenditure effected by the beneficiary with health assistance, in cases of urgency or emergency, when the use of the services of the own, contracted, accredited or otherwise is not possible referenced by the carriers, according to the price ratio of medical and hospital services practiced by the respective product, payable within the maximum of thirty days after the delivery of the appropriate documentation ;
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§ 1º After one hundred and twenty days of the duration of this Act, it is prohibited to offer products of which treat the inciso I and the § 1º of the art. 1º of this Act out of the segmentations of which it treats this article, observed their respective conditions of comprehension and hiring.
§ 2º As of December 3, 1999, of the documentation relating to the hiring of products of which treat the inciso I and the § 1º of the art. 1º of this Act, in the segmentations of which this article is concerned, should contain a separate statement from the consumer, of which he is aware of the existence and availability of the reference plan, and that this has been offered to him. " (NR)
" Art. 13. The product contracts of which treat the inciso I and § 1º of the art. 1º of this Act has automatic renewal from the expiration of the initial term of validity, not by collecting fees or any other value in the act of renewal.
Single Paragraph. The products that it treats the caput, hired individually, will have minimum duration of one year, being veiled:
I-the recount of carencies ;
II-the suspension or unilateral termination of the contract, except for fraud or non-payment of the tuition for period exceeding sixty days, consecutive or not, in the last twelve months of the contract duration, provided that the consumer is proven to be notified up to the fiftieth day of default ; and
III-the suspension or unilateral termination of the contract, in any hypothesis, during the occurrence of internation of the titular. " (NR)
" Art. 14. On the grounds of the age of the consumer, or the condition of a disabled person, no one can be prevented from participating in private health care plans. " (NR)
" Art. 15. The variation in the pecuniary contrastions set out in the product contracts of which they treat inciso I and § 1º of the art. 1º of this Act, on the grounds of the consumer age, can only occur if they are provided for in the initial contract the age brackets and percentage of the incidences incidents in each of them, as per the standards dispatched by the ANS, ressaved the provisions of the art. 35-E.
Single Paragraph. It is vetoed the variation to which you rent the caput to consumers over sixty years of age, who participate in the products of which treat the inciso I and § 1º of the art. 1º, or successors, more than ten years ago. " (NR)
" Art. 16. Of the contracts, regulations or general conditions of the products of which they treat the inciso I and § 1º of the art. 1º of this Act should contain devices that indicate clearly:
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V-the conditions of loss of the quality of beneficiary ;
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VII-the regime, or type of hiring:
a) individual or familiar ;
b) entrepreneurial collective ; or
c) collective by membership ;
VIII-the franchise, the financial limits or the percentage of consumer co-participation or beneficiary, contractually predicted in the expenses with medical, hospital and dental care ;
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X-the geographical area of comprehension ;
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XII-registration number on the ANS.
Single Paragraph. Every individual or family holder of an individual or family plan shall be compulsorily handed over, when from his or her application, copy of the contract, the regulation or the general conditions of the products of which they treat the inciso I and § 1º of the art. 1º, in addition to explanatory material that it describes, in simple and precise language, all its characteristics, rights and obligations. " (NR)
" Art. 17. The inclusion as contractors, referrals or accredited of the products of which treat inciso I and § 1º of the art. 1º of this Act, of any hospital entity, entails commitment to consumers as to their maintenance over the duration of contracts.
§ 1º It is provided for the replacement of hospital entity, the one referred to as the caput of this article, provided that by another equivalent and upon communication to consumers and to ANS with thirty days in advance, within that minimum time limit the cases arising from termination by fraud or infringement of health and fiscal standards in vigor.
§ 2º In the hypothesis of the replacement of the hospital establishment referred to in § 1º occur by willingness of the operator during period of consumer internation, the establishment obliges to maintain the internation and the operator, to pay the expenses up to the high hospital, at the medical discretion, in the form of the contract.
§ 3º Exceed from the provision in § 2º the cases of replacement of the hospital establishment by infraction to the health standards in force, during an internation period, when the operator will shoulder responsibility for the immediate transfer to another equivalent establishment, ensuring continued assistance, with no additional burden for the consumer.
§ 4º In the event of reshaping of the hospital network by reduction, companies should apply for the ANS authorization expresses for so much, informing:
I-name of the entity to be deleted ;
II-operational capacity to be reduced with the exclusion ;
III-impact on assisted mass, from parameters defined by ANS, correlating to need for beds and the remaining operational capacity ; and
IV-justification for the decision, noting the obligation to maintain coverage with standards of equivalent quality and no additional burden for the consumer. " (NR)
" Art. 18. The acceptance, by any service provider or health professional, of the condition of contractor, accredited or co-operated from a product operator of which they treat inciso I and § 1º of the art. 1º of this Act, will entail the following obligations and rights:
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III-the maintenance of hiring relationship, accreditation, or referencing with number unlimited operator, being expressly vetoed to carriers, independent of their constitutive legal nature, to impose exclusivity or restriction contracts on professional activity.
Single Paragraph. As of December 3, 1999, service providers or health professionals will not be able to maintain contract, accreditation or referencing with operators who do not have records for operation and marketing as scheduled in this Act, under penalty of responsibility for irregular activity. " (NR)
" Art. 19. To apply for the definitive operation authorization, the legal persons who already acted as carriers or administrators of the products of which they treat inciso I and § 1º of the art. 1º of this Act, will have a time limit of one hundred and eighty days, from the publication of the specific regulation by ANS.
§ 1º Until the registration standards are expedited, provisional records will be kept of the legal persons and products at the ANS, with the purpose of authorizing the marketing or operation of the products to which you rent the caput, as of January 2, 1999.
§ 2º For the provisional registration, the operators or administrators of the products to which they rent the caput should submit to the ANS the required information and the following documents, regardless of others that come to be required:
I-registration of the legal person's constitution instrument
II-name fantasy ;
III-CNPJ ;
IV-address ;
V-phone, fax and e-mail; and
VI-major leaders of the legal person and name of the posts they occupy.
§ 3º For the provisional registration of the products to be marketed, they should be submitted to the ANS the following data:
I-social reason of the operator or the administrator ;
II-CNPJ of the operator or the administrator ;
III-product name ;
IV-segmentation of assistance (ambulatory, hospital with obstetrics, hospital without obtetrician, dental and reference) ;
V-type of hiring (individual/familiar, corporate collective and collective by membership) ;
VI-geographical scope of coverage ;
VII-age ranges and their prices ;
VIII-hospital network of its own by Municipality (for hospital segmentations and reference) ;
IX-hospital network contracted or referred to by Municipality (for hospital segmentations and reference) ;
X-other documents and information that will come to be requested by ANS.
§ 4º Administrative procedures for provisional registration of products will be dealt with in standard specific to the ANS.
§ 5º Whatever compliance, by the operator, of the formalities of registration provisional, or from the compliance of the texts of the general conditions or contractual instruments, stay guaranteed, to all users of products to which you rent the caput, contracted from January 2, 1999, all access benefits and coverage provided for in this Act and its regulations, for each segmentation defined in art. 12.
§ 6º Non-fulfillment of the provisions of this article implies the payment of daily fine in the value of R$ 10,000.00 (ten thousand reais) applied to the operators of the products of which they treat the inciso I and § 1º of the art. 1º.
§ 7º Legal persons who are to begin marketing operation of private plans of health assistance, as of December 8, 1998, are subject to the records of which it treats § 1º of this article. " (NR)
" Art. 20. The product operators of which treat the inciso I and § 1º of the art. 1º of this Act are required to provide, periodically, to ANS all information and statistics relating to their activities, included those of a cadastral nature, especially those that allow the identification of consumers and their dependent, including their names, inscriptions on the Physical Persons' Cadastro of the holders and Municipalities where they reside, for the purposes of the art. 32.
§ 1º The agents, specially designated by the ANS, for the exercise of the surveillance activities and within the limits set by it, have free access to the carriers, and may request and apprehend processes, contracts, operational routine manuals and other documents, concerning the products of which they treat inciso I and § 1º of the art. 1º of this Act.
§ 2º Characterisation as embarrassments subject to the penalties provided for in the law, the imposition of any difficulty in achieving the objectives of the supervision, of which it treats § 1st of this article. " (NR)
" Art.21. .................................................................................................................................
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II-with a company of which the persons referred to in the inciso I shall be involved, provided that they are, in set or in isolation, considered to be the company's controllers. " (NR)
" Art. 22. ...............................................................................................................................
§ 1º The independent audit may also be required as to the actuarial calculations, drawn up second general guidelines defined by CONSU.
§ 2º The operators with number of recipients less than twenty thousand users are exempted from the publication of the opinion of the auditor and of the financial statements, and the ANS shall give them publicity. " (NR)
" Art. 23. Operators of private health care plans may not apply for bankruptcy and are not subject to bankruptcy or civil insolvency, but-only to the extrajudicial settlement regime.
§ 1º The carriers shall subject to the scheme of bankruptcy or civil insolvency when, in the course of the extrajudicial settlement, are verified one of the following hypotheses:
I-the asset of the liquidanda mass is not sufficient for the payment of at least half of the quirographic credits ;
II-the achievable asset of the liquidanda mass is not sufficient, even, for the payment of the expenses administrative and operational inherent in the regular processing of extrajudicial settlement ; or
III-in the hypotheses of fundata indications of predicted conducts in the arts. 186 a to 189 of Decree-Law No. 7,661 of June 21, 1945.
§ 2º For the purpose of this Act, it defines achievable asset as being all active that can be converted into current currency in compatible time for the payment of the administrative and operational expenses of the liquidated mass.
§ 3º In view of the report of the extrajudicial liquidator, and in checking for any of the hypotheses provided for in the incisos I, II or III of § 1º of this article, ANS may authorize you to apply for the operator's bankruptcy or civil insolvency.
§ 4º The distribution of the application will immediately produce the following effects:
I-the maintenance of the suspension of court deadlines in relation to the liquidated mass ;
II-the suspension of administrative procedures for extrajudicial settlement, save those relating to guard and protection of the goods and real estate of the mass ;
III-the maintenance of the unavailability of the assets of administrators, managers, advisers and resembling, until later judicial determination ; and
IV-avoidance of judgment issuing the first order in relation to the request for conversion of the regime.
§ 5º The ANS, in the case provided for in the inciso II of § 1º of this article, may, in the period understood between the distribution of the application and the declaration of bankruptcy or civil insolvency, support the protection of the movable and immovable property of the liquidated mass.
§ 6º The liquidator will send to the judgment the list of the ongoing judicial actions whose progress will be suspended until the competent judge nominates the liquidator of the bankrupt mass or the liquidator of the insolvent dough. " (NR)
" Art. 24. Whenever detected in the carriers subject to the discipline of this Act insufficient guarantees of financial equilibrium, economic and financial abnormalities or serious administrative ones that jeopardize the continuity or quality of the health care, ANS may determine the disposal of the portfolio, the fiscal or technical steering regime, by non-superior to three hundred and sixty-five days, or extrajudicial settlement, as per the severity of the case.
§ 1º The disfulfillment of the determinations of the fiscal or technical director, and of the liquidator, by leaders, administrators, advisers or employees of the operator of private health assistance plans shall entail the immediate removal of the offender, by decision of the ANS, without prejudice to the criminal penalties that can be imposed, secured the right to adversarial, without this implies a suspensive effect of the administrative decision determining the removal.
§ 2º The ANS, ex officio or on the recommendation of the technical or fiscal director or the liquidator, can, in duly motivated administrative act, determine the removal of directors, administrators, managers and members of the operator's fiscal board under steering or settlement arrangements.
§ 3º Within the time assigned to it, the fiscal or technical director shall conduct the analysis of the organization administrative and financial situation of the operator, as well as the quality of customer service, and will propose to the ANS the cableable measures.
§ 4º The fiscal or technical director will be able to propose the transformation of the steering regime into liquidation extrajudicial.
§ 5º The ANS will promote, within a maximum of ninety days, the disposal of the portfolio of the carriers of private health assistance plans, in the event that no measures have been taken by it determined to remedy irregularities or in situations involving risk to the participating consumers of the portfolio. " (NR)
" Art. 24-A. The administrators of the operators of private health assistance plans in tax direction or extrajudicial settlement, regardless of the legal nature of the operator, will be with all their assets unavailable, not by any form, direct or indirect, alienate them or burden them, until ascertaining and final liquidation of their responsibilities.
§ 1º The unavailability provided for in this article stems from the act that enacts the fiscal direction or the extrajudicial settlement and reaches for all those who have been in the exercise of the duties in the twelve months prior to the same act.
§ 2º In the tax direction regime hypothesis, the unavailability of goods to which the caput of this article may not reach the assets of the administrators, by express deliberation of the Colegated Directorate of the ANS.
§ 3º The ANS, ex officio or on the recommendation of the fiscal or liquidator, may extend the unavailability provided in this article:
I-to the goods of managers, advisers and those of all those who have agreed, in the period provided for in § 1º, for the declaration of the fiscal direction or extrajudicial settlement ;
II-to the goods acquired, to any title, by third parties, in the period provided for in § 1º, of persons referred to in inciso I, since it is set up fraud in the transfer.
§ 4º It does not include in the provisions of this article the goods deemed inalienable or impentable by the legislation in force.
§ 5º The unavailability also does not reach the subject goods of contract of divestment, of promise of purchase and sale, of assignment or promise of assignment of rights, provided that the respective instruments have been brought to the competent public register, previously on the date of the declaration of the tax direction or extrajudicial settlement.
§ 6º The administrators of the operators of private health care plans answer in solidarity with the obligations they have assumed during their management up to the amount of the damage caused, regardless of the causal link. " (NR)
" Art. 24-B. The Collegiate Board will define the tasks and competencies of the technical director, fiscal director and of the portfolio disposal officer, and may extend them, if necessary. " (NR)
" Art. 24-C. Credits arising from the provision of private health care services prefer everyone else except for those of a labor and tax nature. " (NR)
" Art. 24-D. It applies to the extrajudicial liquidation of the operators of private health care plans and the willing in the arts. 24-A and 35-I, in what courier with the precepts of this Act, the provisions of Law No. 6,024 of March 13, 1974, in Decree-Law No. 7,661 of June 21, 1945, in Decree-Law No. 41 of November 18, 1966, and in Decree-Law No 73 of November 21, 1966, as per what to dispose of ANS. " (NR)
" Art. 25. The infractions of the devices of this Act and of its regulations, as well as the devices of the contracts concluded, at any time, between operators and users of private health assistance plans, subject the operator of the products of which treat the inciso I and the § 1º of the art. 1º of this Act, its trustees, members of administrative, deliberative, advisory, fiscal, and similar advice to the following penalties, without prejudice to other established in the current legislation:
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IV-temporary inabilitation for exercise of posts in operator of assistance plans to the health ;
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VI-cancellation of the operating permit and disposal of the operator's portfolio. " (NR)
" Art. 26. The administrators and members of the administrative, deliberative, advisory, fiscal and assorted boards of the carriers of which this Act responds in solidarity with the damages caused to third parties, including to shareholders, cotists, cooperates and consumers of private health assistance plans, as the case may be, in consequence of the failure to comply with laws, standards and instructions regarding the operations provided for in the legislation and, in particular, by the lack of constitution and coverage of the mandatory guarantees. " (NR)
" Art. 27. The fine that it treats the art. 25 will be fixed and applied by the ANS within the scope of its assignments, with a value of not less than R$ 5,000.00 (five thousand reais) and not more than R$ 1,000,000.00 (one million reais) according to the economic size of the operator or service provider and the gravity of the infraction, re-salvaged the provisions of § 6º of the art. 19. " (NR)
" Art. 29. The infractions will be ascertained by administrative process that is based on the self-infringement, the representation or the positive denunciation of the irregular facts, with the ANS having on standards for introduction, resources and their effects, instances and deadlines.
§ 1º The administrative procedure, before applied for penalty, may, on an exceptional basis, be suspended, by the ANS, if the operator or service provider signs termination of an adjustment of conduct, before the collegiate board, which will have extrajudicial executive title effectiveness, obliging to:
I-cease the practice of activities or acts objects from the ascertaining ; and
II-correcting the irregularities, including compensation for the damages arising from them.
§ 2º The term of commitment of conduct adjustment will necessarily contain the following clauses:
I-obligations of the undertake to cease the practical object of the ascertainment, within the time limit established ;
II-worth of the fine to be imposed in the case of discompliance, not less than R$ 5,000.00 (five thousand real) and not more than R$ 1,000,000.00 (one million reais) in accordance with the economic size of the operator or the service provider.
§ 3º The signing of the term of conduct adjustment compromise no matter confession of the commitment as to matter in fact, nor recognition of ilicitude of conduct in ascertainment.
§ 4º The termination of the term of conduct adjustment, without prejudice to the application of the fine as referred to in the inciso II of § 2º, carries the revocation of the suspension of the proceedings.
§ 5º Fulfilled the obligations assumed in the term of commitment of conduct adjustment, will be extinguished the process.
§ 6º Suspend the prescription for the duration of the term of commitment of conduct adjustment.
§ 7º Cannot be firmed term of conduct adjustment when there has been non-compliance with another term of a conduct adjustment commitment under this Act within the two-year period.
§ 8º The term of commitment of conduct adjustment should be published in the Official Journal of the Union.
§ 9º The ANS shall regulate the application of the provisions of § § 1º to 7º of this article. " (NR)
" Art. 29-A. ANS will be able to celebrate with the operative term operators, when there is an interest in the implementation of practices that consist of advantages for consumers, with a view to ensuring the maintenance of the quality of the assistance services to the health.
§ 1º The term of appointment referred to in caput may not imply restriction of rights of the user.
§ 2º In the definition of the term that it treats this article will be considered the criteria for benchmarking and control of the quality of the services to be offered by the carriers.
§ 3º The unjustified discompliance of the term of compromise may matter in the application of the penalty penalty as referred to in the inciso II, § 2º, of the art. 29 of this Act. " (NR)
" Art. 30. To the consumer who contribute to products of which they treat the inciso I and § 1º of the art. 1º of this Act, in connection with an employment bond, in the case of termination or exoneration of the contract of employment without fair cause, is ensured the right to maintain its condition of beneficiary, under the same conditions of assistive cover as it enjoyed when the employment contract is in force, provided that it assumes its full payment.
§ 1º The maintenance period of the beneficiary condition to which the caput refers will be of a third of the time of stay in the products of which they treat the inciso I and § 1º of the art. 1º, or successors, with a guaranteed minimum of six months and a maximum of twenty-four months.
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§ 5º The condition provided in the caput of this article will cease to exist when the admission of the tier consumer in new employment.
§ 6 In the collective plans costed in full by the company, it is not considered contribution to co-participation of the consumer, unique and exclusively, in procedures, as a factor of moderation, in the use of medical or hospital care services. " (NR)
" Art. 31. To the retiree who contribute to products of which treat the inciso I and § 1º of the art. 1º of this Act, in connection with an employment bond, by the minimum ten-year period, is ensured the right of maintenance as a beneficiary, under the same conditions of assistive cover enjoyed when the employment contract has been in force, since that takes your full payment.
§ 1º The retiree that contributes to collective health care plans for lower period to the one established in the caput is ensured the right of maintenance as a beneficiary, at the reason of one year for each year of contribution, provided that it takes full payment of the same.
§ 2º For enjoyment of the right ensured in this article, the same conditions shall be observed. in § § 2º, 3º, 4º, 5º and 6º of the art. 30. " (NR)
" Art. 32. They will be ressarcated by the operators of the products of which they treat the inciso I and § 1º of the art. 1º of this Act, in accordance with standards to be defined by the ANS, the health care services provided for in the respective contracts, provided to their consumers and their dependants, in public or private institutions, convenienced or contractors, members of the Single Health System-SUS.
§ 1º The rebirth to which the caput refers will be effected by the carriers to the entity service provider, when the latter possesses legal personality of its own, and to SUS, upon table of procedures to be approved by the ANS.
§ 2º For the effectivation of the reaction, the ANS will make available to operators the discrimination of the procedures carried out for each consumer.
§ 3º The operator will make the remake up to the fifteenth day after the collection is submitted by ANS, crediting the values corresponding to the provider entity or the respective health fund, as the case is.
§ 4º The rebirth not effected within the time limit provided for in § 3º will be charged with the following additions:
I-interest of living counted from the month following that of maturity, at the reason of one per cent per month or fraction ;
II-fine of lives of ten per cent.
§ 5º The values not collected within the time limit set out in § 3º shall be entered in active debt of the ANS, the which competes for the judicial collection of the respective credits.
§ 6º The proceeds from the raising of interest and the fine of live will be reversed to the National Fund of Health.
§ 7º The ANS shall set standards for the process of gloss or challenge of procedures forwarded, as provided in § 2º of this article.
§ 8º The values to be ressarcated will not be lower than those practiced by SUS and nor superior to those practised by the product operators of which treat inciso I and § 1º of the art. 1º of this Act. " (NR)
" Art. 34. Legal persons performing other activities beyond those covered under this Act should, in the form and within the time defined by the ANS, constitute independent legal persons, with or without profit, specifically to operate plans deprived of health assistance, in the form of the legislation in force and in particular of this Act and its regulations. " (NR)
" Art. 35. The provisions of this Act apply to all contracts concluded from their duration, assured to consumers with previous contracts, as well as to those with contracts concluded between September 2, 1998 and 1º January 1999, the possibility to opt for adaptation to the system envisaged in this Act.
§ 1º Without prejudice to the provisions of art. 35-E, the adaptation of contracts for which this article is intended shall be formalized on its own term, signed by the contractors, in accordance with the standards to be defined by the ANS.
§ 2º When the adaptation of the contracts includes increase in pecuniary contrpression, the composition of the calculation basis should be restricted to the items corresponding to the increased coverage, and will be available for verification by the ANS, which will be able to determine its change when the new value is not properly justified.
§ 3º The adaptation of the contracts does not imply new counting of the grace periods and the time limits of acquisition of the anticipated benefits in arts 30 and 31 of this Act, observed, as to the latter, the coverage limits provided for in the original contract.
§ 4º No contract can be adapted by unilateral decision of the operator company.
§ 5º The maintenance of original contracts by non-opting consumers has character personal impersonation, and must be guaranteed only to the holder and its already-registered dependents, permitted inclusion only of new spouse and children, and vetoed the transfer of their entitlement, under any pretext, to third parties.
§ 6º The products of which treat the inciso I and the § 1º of the art. 1º of this Act, contracted up to 1º from January 1999, should remain in operation, for an indefinite time, only for consumers who do not opt for adaptation to the new rules, being considered extinct for commercialization.
§ 7º To legal persons contractors of collective plans, non-opting for the intended adaptation in this article, the maintenance of the original contracts shall be ensured, in the assistive covers in them paced.
§ 8º The ANS will in its own standard define the formal procedures that are to be adopted by the companies for the admonitor of the contracts that it treats this article. " (NR)
" Art. 35-A. It is established the Supplementar Health Council-CONSU, an integral collegiate body of the regimental structure of the Ministry of Health, with competence to:
I-establish and supervise the execution of general policies and guidelines of the health sector supplemental ;
II-approve the management contract of the ANS ;
III-supervise and monitor the actions and functioning of the ANS ;
IV-set general guidelines for implementation in the supplemental health sector on:
a) econo-micro-financial aspects ;
b) accounting, actuarial and statistical standards ;
c) parameters as to the capital and minimum net worth, as well as to the shapes of its subscription and realization when it is an anonymous society ;
d) criteria for constituting guarantees of maintenance of economic and financial equilibrium, consistent in goods, furniture or real estate, or special funds or secured insurers ;
e) creation of background, insurance contracting or other instruments that judge appropriate, with the aim of protecting the consumer from private health care plans in the event of insolvency of carriers ;
V-deliberating on the creation of technical chambers, of an advisory character, in order to subsidize their decisions.
Single Paragraph. The ANS shall set the standards on the matters provided for in the inciso IV of this article, and shall comply with them, if necessary, when there are general guidelines laid down by the CONSU. " (NR)
" Art. 35-B. CONSU will be integrated by the following Ministers of State:
I-Head of the Civil House of the Presidency of the Republic, in the capacity of President ;
II-of Health ;
III-of the Fazenda ;
IV-of Justice ; and
V-from Planning, Budget and Management.
§ 1º The Council shall act upon resolutions, by a majority of votes, with the President to prerogative to deliberate in cases of urgency and relevant interest, ad referendum of the remaining members.
§ 2º When deliberating ad referendum of the Council, the President shall submit the decision to the Colegary in the first meeting that follows that deliberation.
§ 3º The President of the Council will be able to invite Ministers of State, as well as other representatives of public bodies, to take part in the meetings, not being allowed the right to vote.
§ 4º The Council shall meet whenever it is convened by its Chairperson.
§ 5º The internal regiment of the CONSU will be approved by decree of the President of the Republic.
§ 6º The administrative support activities to CONSU will be provided by the ANS.
§ 7º The President of the ANS shall participate, as Secretary, of the meetings of the CONSU. " (NR)
" Art. 35-C. It is mandatory to coverage of the care in the cases:
I-of emergency, as such defined those that entail immediate risk of life or injury irreparable for the patient, characterized in declaration of the assistant doctor ; and
II-of urgency, thus understood those resulting from personal accidents or complications in the gestational process.
Single Paragraph. ANS will make the publication of regulatory standards for the provisions of this article, observed the terms of adaptation provided for in art. 35. " (NR)
" Art. 35-D. The fines to be imposed by the ANS on the basis of the supervisory and normative competence established in this Act and in its regulations will be collected from the account of that Agency, up to the limit of R$ 1,000,000.00 (one million reais) per infraction, re-salvaged the provisions of § 6º of the art. 19 of this Act. " (NR)
" Art. 35-E. As of June 5, 1998, it is established for contracts concluded earlier than the effective date of this Act which:
I-any variation in pecuniary contrpression for consumers with more than sixty years of age will be subject to prior authorization of ANS ;
II-the claim of disease or preexisting injury will be subject to prior regulation of the subject matter by ANS ;
III-is vetoed the suspension or unilateral termination of the individual or family contract of products of which treat the inciso I and § 1º of the art. 1º of this Act by the operator, except the provisions of the inciso II of the sole paragraph of art. 13 of this Act ;
IV-is vetoed to disruption of hospital internation in clinical, surgical or center-center intensive or similar therapy, save at the discretion of the assistant physician.
§ 1º The previous contracts for the duration of this Act, which establish readjustment by change of track age initial in sixty years or more, they should be adapted, by October 31, 1999, for repacing the re-adjustment clause, observed the following provisions:
I-repacement will be guaranteed to consumers that it treats the single paragraph of art. 15, for the age bracket changes occurring after the duration of this Act, and shall be limited to the dilution of the application of the previously anticipated readjustment, in annual partial readjustments, with fixed percentage adoption which, applied each year, allow to reach the integral reset at the beginning of the last year of the age group considered ;
II-for application of the dilution formula, they consider ten years the age ranges they have been stipulated without upper limit ;
III-the new clause, containing the application formula of the readjustment, should be forwarded to the consumers, together with the bolt or collection title, with the demonstration of the originally contracted value, the repaced value and the percentage of fixed annual readjustment, further clarifying that their payment will formalize this repactutment ;
IV-the original readjustment clause must have been previously submitted to the ANS ;
V-in the lack of prior approval, the operator, so that it can apply readjustment by age group to consumers with sixty years or older and ten years or more of contract, should submit to ANS the contractual conditions accompanied by technical note, for, once the clause and the percentage of readjustment, to adopt the dilution provided for in this paragraph.
§ 2º In the individual product contracts of which they treat the inciso I and § 1º of the art. 1º of this Act, regardless of the date of its celebration, the application of adjustment clause of the pecuniary contractuations will depend on prior approval of the ANS.
§ 3º The willing on art. 35 of this Act applies without prejudice to the established in this article. " (NR)
" Art. 35-F. The assistance to which you rent the art. 1º of this Act comprises all actions necessary for the prevention of disease and the recovery, maintenance and rehabilitation of health, observed the terms of this Act and of the contract struck between the parties. " (NR)
" Art. 35-G. They apply subsidarily to contracts between users and product operators of which they treat the inciso I and § 1º of the art. 1º of this Act the provisions of Law No. 8,078 of 1990. " (NR)
" Art. 35-H. The expedients that up to this date have been filed in SUSEP by the product operators of which treat the inciso I and § 1º of the art. 1º of this Act and which are referred to the ANS in consequence of this Act, should be accompanied by conclusive opinion of that Autarquia. " (NR)
" Art. 35-I. They will respond by subsidisation by the contractual and legal rights of consumers, service providers and suppliers, in addition to tax and labor debts, the personal assets of directors, administrators, managers and members of advice of the private plan operator for health care, regardless of its legal nature. " (NR)
" Art. 35-J. The technical or fiscal director or liquidator is required to maintain secrecy concerning the information of the operator to which they have access in reason of the exercise of the charge, on the penalty of incurring administrative improbity, without prejudice to the civil and criminal responsibilities. " (NR)
" Art. 35-L. The guarantor goods of technical provisions, funds and provisions shall be registered at the ANS and shall not be able to be disposed of, promised to divvy or, in any form, recorded without prior and express permission, being void, of full right, the disposals carried out or the engravings constituted with violation of this article.
Single Paragraph. When the guarantee falls in real estate, it will be compulsorily entered in the competent Carthorium of the General Registration of Real Estate, upon application made by the health care provider and the ANS. " (NR)
" Art. 35-M. The product operators of which treat the inciso I and § 1º of the art. 1º of this Act will be able to enter into reinsurance contracts with companies duly authorized to operate in such activity, as set out in Law No. 9,932 of December 20, 1999, and later regulations. " (NR)
Art. 2º The arts. 3rd, 5th, 25, 27, 35-A, 35-B, 35-D and 35-E of Law No. 9,656 of June 3, 1998, shall enter into force on June 5, 1998, resguarded to the legal persons of which it treats art. 1º the deadline of December 31, 1998 for adaptation to the one with the arts. 14, 17, 30 and 31.
Art. 3º The Executive Power will be publishing in the Official Journal of the Union within thirty days, after the conversion of this Provisional Measure into law, consolidated text of Law No. 9,656, of 1998.
Art. 4º Law No. 9,961 of January 28, 2000, passes vigorously with the following changes:
" Art.4º .................................................................................................................................
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XVII-authorize readjustments and revisions of the pecuniary contractuals of private plans of health care, heard the Ministry of Finance ;
........................................................................................................................................................
XXII-authorize registration and operation of the operators of private assistance plans to the health, as well its division, merger, incorporation, alteration or transfer of the societal control, without prejudice to the provisions of Law No. 8,884 of June 11, 1994 ;
.................................................................................................................................................................
XXXIV-proceed to the extrajudicial settlement and authorize the liquidator to apply for bankruptcy or civil insolvency of the operators of private health care plans ;
XXXV-determine or promote the disposal of the portfolio of private health care plans of the operators ;
.................................................................................................................................................................
XXXIX-celebrate, in the conditions that establish, term of commitment of adjustment of conduct and term of commitment and to scrutinise your compliments ;
XL-define the tasks and competencies of the technical director, fiscal director, the liquidator and the responsible for the disposal of wallet.
XLI-set the standards for the constitution, organization, operation and supervision of operators of products of which treat the inciso I and § 1º of the art. 1º of Law No. 9,656 of June 3, 1998, including:
a) assistecial contents and models ;
b) suitability and use of technologies in health ;
c) fiscal or technical direction ;
d) extrajudicial settlement ;
and) financial recovery procedures of carriers ;
f) standards of application of penalties ;
g) assisuntential guarantees, for coverage of the commercial plans or products or made available ;
XLII-stipulate indexes and other technical conditions on investments and other relations heritage to be observed by carriers of health care plans.
§ 1º The refusal, omission, false-age or unwarranted retardation of information or documents requested by the ANS constitutes infraction punishable with a daily fine of R$ 5,000.00 (five thousand reais), and may be increased by up to twenty times, if necessary, to ensure its effectiveness in reason of the economic situation of the operator or the provider of services.
............................................................................................................................................... " (NR)
" Art.10. ................................................................................................................................
........................................................................................................................................................
§ 1º The Board will meet with the presence of at least three directors, among them the Director-President or his legal substitute, and will deliberate with, at the very least, three coincident votes.
§ 2º Of the acts practiced by the Directors will be able to appeal to the Board Colegiated as last instance administrative.
............................................................................................................................................... " (NR)
Art. 13. ...............................................................................................................................
........................................................................................................................................................
IV- .......................................................................................................................................
........................................................................................................................................................
p) National Federation of Private Insurance and Capitalisation Companies ;
q) Brazilian Medical Association ;
V- .........................................................................................................................................
a) of the health care self-management segment ;
b) of the group medicine companies ;
c) of the medical services cooperatives acting on supplemental health ;
d) of the group dental companies ;
e) of the dental service cooperatives acting in the area of supplementary health ;
VI-by two representatives of entities hereinafter stated:
a) consumer protection ;
b) of consumer associations of private health care plans ;
c) of the entities with disabilities and special pathologies.
.................................................................................................................................................................
§ 2º The entities of which they treat the points of the incisos V and VI will choose from each other, within each category, their representatives and their respective alternates in the Supplemental Health Chamber. " (NR)
"Art.20 ............................................................................................................................................................................................................................................................................................
§ 6º The operator of private health care plans that fall within the segments of self-management by human resources department, or philanthropy, or that have number of users less than twenty thousand, or that plummets, on their own network, more than sixty per cent of the assistive cost relative to spending on services hospital regarding your Private Health Assistance Plans and who provide at least thirty per cent of your activity to the Single Health System-SUS, will do jus at a thirty per cent discount on the amount calculated in the form of the inciso I of this article, as you dispose of ANS.
§ 7º The operators of private health care plans that exclusively commercialize plans dental will make jus at a discount of fifty per cent on the amount calculated in the form of the inciso I of this article, as per the ANS.
§ 8º The carriers with number of users less than twenty thousand will be able to opt for the pickup in single installment in the month of March, making jus at a five per cent discount on the amount calculated in the form of the inciso I of this article, in addition to the discounts provided for in § § 6º and 7º, as per the ANS.
§ 9º The values listed in Annex III of this Act shall be reduced by fifty per cent, in the case of companies with number of users less than twenty thousand.
§ 10. For the purposes of the provisions of the inciso II of this article, the cases of alteration of data concerning products or operator, up to issue of the standard corresponding to their definitive records, as per the provisions of Law No. 9,656 of 1998, shall be exempt from the respective Supplemental Health Rate.
§ 11. For the purposes of the provisions of the inciso I of this article, in the cases of compulsory disposal of portfolio, the operators of private health care assistance plans shall be exempt from payment of the respective Supplementary Health Rate, relative to the member beneficiaries of that portfolio, by the five-year term. " (NR)
" Art.21. ................................................................................................................................
.................................................................................................................................................................
§ 1º The débites concerning the Supplementary Health Rate may be parceled, the judgement of the ANS, of agreement with the criteria laid down in the tax legislation.
§ 2º In addition to the accruals provided for in the incisos I and II of this article, the non-pickup of the Rate of Supplemental Health will entail the loss of discounts provided for in this Act. " (NR)
" Art. 33. ANS shall designate physical person of proven capacity and experience, recognized moral suitability and registration on the supervisory board of regulated professions, to exercise the charge of fiscal, technical or liquidator director of operator of private health care plans.
§ 1º The remuneration of the technical director, the fiscal director or the liquidator should be borne by the operator or by the mass.
§ 2º If the carrier or the dough does not have the resources to cost the remuneration it treats this article, ANS may exceptionally promote this payment, in value equivalent to that of the post on board of Executive Management, level III, CGE-III symbol, rescind of the values expended with interest and monetary correction together with the operator or the mass, as per the case. " (NR)
Art. 5º O § 3º of the art. 1º of Law No. 10,185 of February 12, 2001, passes vigorously with the following essay:
" § 3º Caberá, exclusively, to the Supplemental Health Council-CONSU, pursuant to Law No. 9,656, 1998, and to the ANS under Law No. 9,961 of 2000, discipline the insurance that it treats this article as to the subjects provided for in the incisos I and IV of the art. 35-A of the said Law No. 9,656, 1998, and on art. 4º of Law No. 9,961, 2000, as well as on the authorisation of operation and the operation of specialized insurers. " (NR)
Art. 6º Stay convalidated the acts practiced on the basis of the Provisional Measure No. 2.177-43 of July 27, 2001.
Art. 7º This Provisional Measure shall come into force on the date of its publication.
Art. 8º Stay revoked the arts. 2º to 7º, the inciso VIII of the art. 10, the § 3º of the art. 12, the single paragraph of art. 27 and the art. 28 of Law No. 9,656 of June 3, 1998, and § 3º of the art. 4º of Law No. 9,961 of January 28, 2000.
Brasilia, August 24, 2001 ; 180º of the Independence and 113º of the Republic.
FERNANDO HENRIQUE CARDOSO
Jose Gregori
Pedro Malan
Jose Serra
Pedro Parente
Attachment (s)
