Key Benefits:
PROVISIONAL MEASURE # 2.097-37, OF February 23, 2001
Amend the Act No. 9,656 of June 3, 1998, which has on the private plans for health assistance 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 The devices listed below under Law No. 9,656 of June 3, 1998 pass 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 applying the standards here established, the following definitions:
I-Private Health Assistance Plan: continued provision of services or coverage of assisteous costs at pre-or post-established price, for an indefinite period, with the purpose of ensuring, without financial limit, assistance to health, by the faculty of access and care by professionals or health services, freely chosen, members or non-networked, contracted or referenced network, targeting medical, hospital and dental care, to be paid integral or partially at the expense of the contracted operator, upon reimbursement and direct payment to the provider, on account of and order of the consumer ;
II-Health Assistance Plan Operator: legal person constituted under the modality of civil or commercial, cooperative society, or self-management entity, which operates product, service or contract of which it treats inciso I of this article ;
III-Portfolio: the set of assisted-cost coverage contracts or health care services in any of the modalities of which they treat inciso I and § 1º of this article, with all rights and obligations in it contained.
§ 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 health care risks, hospital and dental, 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 provider ; and
f) binding financial coverage to the application of concepts or medical-assister criteria.
§ 2º Include in the scope of this Act the cooperatives that operate the products of which they treat 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 or legal persons residing or domiciled abroad may constitute or participate in the capital, or increase in capital, of legal persons under private law constituted under Brazilian laws to operate private plans for health care.
§ 4º It is vetoed to the physical persons the operation of the products of which they treat the 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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Single Paragraph. They are exempted from compliance with the conditions set forth in the incistes VI and VII of this article, the entities or companies that maintain private health care systems in the modality of self-management, cited in § 2º of the art. 1º. " (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 companies that operate the products of which treat the 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 disfulfillment of the formalities provided for in this article, in addition to setting infringement, constitutes aggravating in the application of penalties for infringing on 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. " (NR)
" Art. 10. The health care assistance-reference plant is instituted, with medical-hospital assistive coverage, comprising parts and treatments, performed exclusively in Brazil, with standard of infirmary, intensive care center, or similar, when required the hospital internation, of the diseases listed in the International Statistical Classification of Health Diseases and Problems Related to Health, the World Health Organization, respected the minimum requirements set out in 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 Companies that 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 to entities or companies that maintain health care systems by the modality of self-management and the companies that operate exclusively dental plans.
§ 4º The breadth of covers, inclusive of 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 physician ;
II-.............................................................................
a) coverage of hospital internations, vegin with time limitation, maximum value and quantity, in basic and specialized clinics, recognized by the Federal Medical Council, admitting to the exclusion of procedures obstintric ;
b) coverage of hospital internation in intensive care center, or similar, vegin with time limitation, maximum value and quantity, at the discretion of the assistant physician ;
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d) coverage of complementary examinations indispensable for the control of disease evolution and elucidation diagnostic, supply of medicinal products, anesthetics, medicinal gases, transfusions and chemotherapy and radiotherapy sessions, as per the prescription of the assistant physician, performed or delivered during the hospital internation period ;
e) coverage of any and any fee, including materials used, as well as the removal of the patient, proven necessary, for another hospital establishment, in Brazilian territory, within the limits of comprehension geographical predicted in the contract ;
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III-............................................................................
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b) enrolment ensured to the newborn, natural child or consumer adoptive, as a dependent, exempt from the fulfillment of the grace periods, provided that the inscription occurs within 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, the offer of products of which treat inciso I and § 1º of the art is prohibited. 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 they treat inciso I and § 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, save for fraud or non-payment of tuition for a period of more than sixty days, consecutive or not, in the last twelve months of the contract, 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 the internation of the holder. " (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 co-participation of the consumer or beneficiary, contractually anticipated 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.
§ 1º Every individual or family holder of an individual or family plan shall be compulsorily handed over, when from his / her enrolment, copy of the contract, the regulation or 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, from 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 referred to in the caput of this article, provided that by another equivalent and upon communication to consumers and to ANS thirty days in advance, ressaved from that minimum time limit for cases arising from termination by fraud or infringement of the health and fiscal standards in force.
§ 2º In the assumption that the replacement of the hospital establishment referred to in the preceding paragraph occurs at the will of the operator during a consumer internation period, 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 the preceding paragraph of the replacement cases of the hospital establishment for 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 the continuation of assistance, with no additional burden on the consumer.
§ 4º In the event of resizing the hospital network by reduction, companies should apply for the express authorization 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 the ANS, correlating the need for beds and the remaining operational capacity ; and
IV-justification for the decision, noting the obligation to maintain coverage with equivalent quality standards and without 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 unlimited number of carriers, being expressly vetoed to carriers, independent of their constitutive legal nature, impose contracts of uniqueness or restriction to 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 provided for in this Law, 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 of the companies and products on the ANS shall be kept, with the purpose of authorizing the marketing or operation of the products to which the caputrents, to be from of January 2, 1999.
§ 2º For the provisional registration, the operators or administrators of the products to which you rent the caput should submit to the ANS the required information and the following documents, regardless of any other ones that come to be required:
I-registration of the company's constitution document ;
II-name fantasy ;
III-CNPJ ;
IV-address ;
V-phone, fax and e-mail; and
VI-top leaders of the company and name of the posts they occupy.
§ 3º For the provisional registration of the products to be marketed, the following data should be submitted to the ANS:
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 obstetrics, 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 referenced by Municipality (for hospital segmentations and referral) ; and
X-other documents and information that are requested by ANS.
§ 4º Administrative procedures for provisional registration of products will be dealt with in specific standard of ANS.
§ 5º Whatever the operator's compliance, the formalities of the provisional registration, or the conformity of the texts of the general conditions or the contractual instruments, shall be guaranteed, to all users of products to which you rent the caput, contracted from January 2, 1999, all the benefits of access and coverage provided for in this Act and in its regulations, for each segmentation defined in art. 12.
§ 6º The non-compliance of the provisions of this article implies the payment of a daily fine worth 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 initiate commercialization operation of private health care plans, 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 the CONSU, have free access to the carriers, and may request and learn processes, contracts, manuals of operational routine and other documents, concerning the products of which treat the inciso I and the § 1º of the art. 1º of this Act.
§ 2º Characterisation as embarrassments to the supervision, subject to the penalties provided for in the Act, the imposition of any difficulty in achieving the objectives of the surveillance, of which it treats § 1º of this article. " (NR)
" Art. 21. ....................................................................
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II-with a company of which the persons referred to in the previous incision shall be involved, provided that these are, either jointly or in isolation, considered to be the parent company. " (NR)
" Art. 22. ....................................................................
Single Paragraph. The independent audit may also be required as to the actuarial calculations, drawn up in accordance with standards defined by CONSU. " (NR)
" Art. 23. Operators of private health care plans may not apply for bankruptcy and are not subject to bankruptcy, but-only to the extrajudicial settlement regime.
§ 1º The carriers shall subject themselves to the judicial settlement procedure when, in the course of the extrajudicial settlement, one of the following hypotheses is verified:
I-the asset of the liquidanda mass is not sufficient for the payment of at least half of the quirographic credits ; or
II-the achievable asset of the liquidanda mass is not sufficient, even, for the payment of the administrative and operational expenses inherent in the regular processing of the extrajudicial settlement.
§ 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 verifying the hypothesis provided for in the inciso II of § 1º of this article, the ANS shall request the declaration of the judicial settlement, by staying the extrajudicial settlement suspended until the decision of judgment.
§ 4º The suspension of extrajudicial settlement will produce the following effects:
I-the exoneration of the liquidator by the ANS ;
II-the assumption, by ANS, of exclusive jurisdiction, in relation to the liquidated mass, of being the guarantor faithful of its assets and documents ;
III-the maintenance of the unavailability of the assets of administrators, managers, advisors and resembling them, until further judicial determination ; and
IV-prevention of judgment issuing the first order in relation to the request for the conversion of the
§ 5º The ANS shall send to the judgment the list of the ongoing judicial actions whose progress will be suspended until the competent judge nominates the judicial liquidator. " (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-higher than one hundred and eighty 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 directors, administrators, advisers or employees of the operator of private health assistance plans will entail immediate removal of the offender, by decision of the ANS, without prejudice to the enforceable criminal penalties, ensured the right to the adversarial, without prejudice to the suspensive effect of the administrative decision which determined the removal.
§ 2º The ANS, ex officio or on the recommendation of the technical or fiscal director or the liquidator, may, in duly motivated administrative act, determine the removal of the directors, administrators, managers and members of the fiscal board of the operator under steering or in liquidation arrangements.
§ 3º Within the time assigned to it, the fiscal or technical director shall conduct the analysis of the administrative organization and the economic and financial situation of the operator, as well as the quality of the consumer service, and 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 extrajudicial settlement.
§ 5º The ANS shall promote, within the maximum period of ninety days, the disposal of the portfolio of the operators of private health assistance plans, in the event that the measures by it determined to remedy the irregularities or in the situations that involve 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 tax direction or 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 referred to in the caput of this article may not achieve the assets of the administrators, by express deliberation of the Colegiated Board of the ANS.
§ 3º The ANS, ex officio or on the recommendation of the Fiscal Director or Liquidante, may extend the unavailability provided for 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 tax direction or extrajudicial settlement ;
II-to the goods acquired, to any title, by third parties, in the period provided for in § 1º, of the persons referred to in the previous incision, provided that it is set up fraud in the transfer.
§ 4º It is not included 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 disposal, 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 registration, previously at the date of the declaration of the tax direction or extrajudicial settlement.
§ 6º The administrators of the operators of private health care plans respond in solidarity with the obligations they undertake during their management up to the amount of the damage caused, regardless of the nexus of causality. " (NR)
" Art. 24-B. The Collegiate Board will define the assignments and competencies of the Technical Director, Fiscal Director and the responsible for the disposal of portfolio, 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 assistance plans, in what couber and does not clash with the precepts of this Act, the provisions of the Laws No 6,024 of March 13, 1974, and 6,435, of July 15, 1977, and in the Decree-Law No. 73 of November 21, 1966, as per the disposing of the 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 office exercise in operator of health care plans ;
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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 board collegiate, which will have extrajudicial executive title effectiveness, compelling yourself 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 engagement of conduct adjustment will necessarily contain the following clauses:
I-obligations of the undertake to cease the practical object of the apuration, within the time limit set ;
II-value of the fine to be imposed in the case of discompliance, not less than R$ 5,000.00 (five thousand reais) 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 termination compromise term does not matter any confession of the arbitration as to matter of fact, nor recognition of ilicitude of conduct in ascertainment.
§ 4º The termination of the term of a conduct adjustment compromise, without prejudice to the application of the fine referred to in the inciso II of § 2º, carries out the revocation of the suspension of the proceedings.
§ 5º Fulfilled the obligations assumed in the term of conduct adjustment commitment, will be extinguished the process.
§ 6º Suspend the prescription for the duration of the term of commitment of conduct adjustment.
§ 7º It may not be an agreed term of conduct adjustment when there has been disfulfillment of another term of conduct adjustment commitment under this Act within the two-year period.
§ 8º The term of commitment of conduct adjustment is to 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. 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 referred to in the caput shall be one 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 titular consumer in new employment.
§ 6º In the collective plans costed in full by the Company, it is not considered contribution to co-participation of the consumer, solely and exclusively, in procedures, as a factor of moderation, in the use of the services of medical or hospital assistance. " (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 When retired that contribute to collective health assistance plans per period lower than that set in the caput is ensured the right of maintenance as a beneficiary, to the reason of one year for each year of contribution, provided that you assume full payment of the same.
§ 2º For enjoyment of the right ensured in this article, the same conditions set out in § § 2º, 3º, 4º, 5º and 6º of the preceding Article shall be observed. " (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 referred to in the caput will be effected by the carriers to the 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 remake, SUS managers will make available to operators the discrimination of procedures performed for each consumer.
§ 3º The operator will make the rebirth until the fifteenth day after the presentation of the collection by the ANS, crediting the corresponding values to the provider entity or the respective health fund as the case may be.
§ 4º The rebirth not effected within the time limit provided for in the preceding paragraph shall be charged with the following additions:
I-interest of living counted from the month following that of maturity, to the reason of one per cent to the month or fraction ;
II-fine of lives of ten per cent.
§ 5º The figures not collected within the time limit provided for in § 3º shall be entered in active debt of the ANS, which shall be responsible for the judicial collection of the respective claims.
§ 6º The proceeds from the raising of interest and the fine of live will be reverted to the National Health Fund.
§ 7º The ANS shall set standards applicable to the gloss or dispute procedure of the forwarded procedures, as provided for in § 2º of this article.
§ 8º The values to be terminated will not be lower than those practiced by SUS and nor superior to those practised by the product operators of which they treat inciso I and § 1º of the art. 1º of this Act. " (NR)
" Art. 34. Entities performing other activities beyond those covered under this Act should, in the form and timeframe defined by the ANS, constitute independent legal persons, with or without profit, specifically to operate private plans 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 concerned, 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 increased cash contravention, the composition of the calculation basis should be restricted to the items corresponding to the increase in coverage, and will be available for verification by the ANS, which will be able to determine your 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 deadlines for acquiring the benefits provided for in the 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 a personal character, and should be guaranteed only to the holder and its already-enrolled 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 The ANS will in its own standard define the formal procedures that are to be adopted by the companies for the adaptation of the contracts of which this article is concerned. " (NR)
Art. 2º Law No. 9,656 of June 3, 1998 passes the following articles in addition to the following articles:
" 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 implementation of general policies and guidelines of the supplemental health sector ;
II-approve the management contract of the ANS ;
III-supervise and monitor the actions and functioning of the ANS ;
IV-set general guidelines for the constitution, organization, operation and supervision of the products operators of which treat inciso I and § 1º of the art. 1º of this Act, including:
a) assistecial contents and models ;
b) suitability and use of technologies in health ;
c) econo-micro-financial aspects ;
d) accounting, actuarial and statistical standards ;
e) parameters as to the capital and minimum net worth, as well as to the forms of its underwriting and realization when it comes to the anonymous society ;
f) criteria for constitution of maintenance guarantees of economic and financial equilibrium, consistent in goods, furniture or real estate, or special funds or secure guarantors ;
g) background creation, secure insurance hiring or other instruments that it believes appropriate, with the aim of protecting the consumer from private health care plans in the event of insolvency of carriers ;
h) fiscal or technical direction ;
i) extrajudicial settlement ;
j) financial recovery procedures of carriers ;
l) standards of application of penalties ;
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 the prerogative to deliberate in the cases of urgency and relevant interest, ad referendum of the other 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 other representatives of public bodies, to attend 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 involving immediate risk of life or irreparable injury to the patient, characterized in declaration by the assistant physician ; and
II-of urgency, thus understandings of 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 contraction for consumers over sixty years of age will be subject to the prior authorization of the ANS, heard the Ministry of Finance ;
II-the allegation of disease or preexisting injury will be subject to prior regulation of matter by ANS ;
III-is vetoed with suspension or unilateral termination of the individual or family contract of products of which they treat 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 the interruption of hospital internation in clinical, surgical or intensive care center or similar therapy, save at the discretion of the assistant physician.
§ 1º Previous contracts for the duration of this Act, which establish adjustment for change of age group with initial age in sixty years or more, should be adapted, by October 31, 1999, for repacing the clause of readjustment, 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 full resetting at the beginning of the last year of the age group considered ;
II-for application of the dilution formula, the age ranges which have been stipulated without upper limit shall be considered to be ten years ;
III-the new clause, containing the application formula of the readjustment, should be forwarded to 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 adjustment, 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 absence of prior approval, the operator, so that it can apply for an age bracket to consumers aged sixty years or older and ten years or more of contract, should submit to ANS the contractual conditions accompanied by of technical note, for, once the clause is approved 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 the tax and labor debts, the personal assets of directors, administrators, managers and members of advice of the private plan operator of health care, regardless of their legal nature. " (NR)
" Art. 35-J. To the arts. 24-A and 35-I apply, when couber, the willing in the arts. 37 and 38 of Law No. 6,024 of March 13, 1974. " (NR)
" Art. 35-L. 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. 3º The arts. 3º, 5º, 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 in 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. 4º The Executive Power shall publish 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. 5º The arts. 4º, 20, 21 and 33 of Law No. 9,961 of January 28, 2000, pass vigorously with the following changes:
" Art. 4º ......................................................................
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XXXIV-proceed to the extrajudicial settlement and apply for the judicial liquidation of the operators of private health care plans ;
XXXV-determine or promote the disposal of the portfolio of private health care plans of the carriers ;
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XXXIX-celebrate, in the conditions that it establishes, term of commitment of conduct adjustment and to scrutinize its compliance ;
XL-define the assignments and competencies of the Technical Director, Fiscal Director, the Liquidante and the portfolio disposal officer.
§ 1º The refusal, omission, falseness or unwarranted retardation of information or documents requested by the ANS constitutes infraction punishable by a daily fine of R$ 5,000.00 (five thousand reais), and may be increased by up to twenty times, if necessary, to ensure their effectiveness on the grounds of the economic situation of the operator or service provider.
......................................................................... " (NR)
" Art. 20. ....................................................................
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§ 6º The operators of private health care plans that fall within the self-management segments by human resources department, philanthropy and dentistry and that plummets, on their own network, more than sixty per cent per cent. cent of the assistive cost pertaining to spending on hospital services regarding your Private Health Care Plans and who provide at least thirty percent of your activity to the SUS Single Health System, will do jus at a thirty-percent discount per cent over the amount due, as it disposes to ANS.
§ 7º The carriers with number of recipients less than twenty thousand users will be able to opt for the pick-up in single instalment in the month of March, making jus at a discount, on the amount due, of five per cent, as per the ANS.
§ 8º The values set out in Annex III of this Act are reduced by thirty per cent, in the case of companies with number of recipients less than twenty thousand users. " (NR)
" Art. 21. ....................................................................
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§ 1º The débites concerning the Supplementary Health Rate may be parceled, the judgement of the ANS, in accordance 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 Supplementary Health Rate will entail the loss of discounts provided for in this Act. " (NR)
" Art. 33. ANS will be able to assign server or employee of the Federal Public Administration, directly or indirectly, to exercise the charge of Tax Director, Technical Director or Liquidator of private health care provider with remuneration equivalent to that of office in Executive Management commission, level III, CGE-III symbol. " (NR)
Art. 6º Stay convalidated the acts practiced on the basis of the Provisional Measure No. 2.097-35 of December 27, 2000.
Art. 7º This Provisional Measure comes into force on the date of its publication.
Art. 8º Ficam revoked the arts. 2º, 3º, 4º, 5º, 6º and 7º, the inciso VIII of the art. 10, the § 3º of the art. 12, the § 2º of the art. 16, the single paragraph of art. 27, and the art. 28 of Law No. 9,656 of June 3, 1998.
Brasilia, February 23, 2001 ; 180º of Independence and 113º of the Republic.
FERNANDO HENRIQUE CARDOSO
Silvano Gianni
