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Other news
Health: bill creates new mechanism to protect the insured
Deputy Amom Mandel (Cidadania/AM) introduced a bill on (Dec 22) amending the “Health Law” (9,656/98) to establish the Qualified Waiting Period Portability (Portabilidade Qualificada por Carência, PQC) mechanism in cases of unilateral termination or expiration of private plan contracts.
According to the proposal, this new mechanism will serve as a guarantee of continuity of care and protection for the beneficiary, to be applied on a mandatory basis where the contractual relationship ends for reasons other than default or fraud by the consumer.
Qualified Waiting Period Portability (PQC) applies to individual, family, collective by adhesion and employer-sponsored collective contracts, and will be due in the following situations: unilateral termination or suspension of the contract at the initiative of the operator; termination or suspension of the collective contract at the initiative of the policyholder (employer, association or contracting legal entity), including through replacement of the operator or of the contracted product; or extrajudicial liquidation or bankruptcy of the operator or of the policyholder.
Under PQC, the period of uninterrupted membership of the beneficiary in the original plan will be counted in full toward meeting waiting periods and Temporary Partial Coverage (CPT) in the destination plan.
The proposal prohibits the application of new waiting periods or a new CPT period, provided that the equivalent periods have already been fully met under the previous contract. This includes waiting periods for high-complexity procedures (PAC) and hospitalizations.
Saúde: projeto cria novo mecanismo de proteção do segurado – CQCS
Sources: Federal Official Gazette (DOU) and the ANS website. Press items link to the original article. This brief is for information only and does not constitute legal advice.