The Superior Court of Justice (STJ) understood that the list of procedures and events established by the National Health Agency (ANS) is exhaustive, as a rule, and health insurance companies are not obliged to cover treatments not included in the list.
However, the panel established parameters so that, in exceptional situations, plans may cover procedures not included in the list, such as therapies recommended by a doctor, without a therapeutic substitute on the list, and which must be proven by technical bodies and approved by institutions that regulate the sector.
Furthermore, the STJ ruled that it is possible to contract expanded coverage or negotiate a contractual addendum for coverage of extra-list procedures and that, if there is no therapeutic substitute or the procedures on the ANS list have been exhausted, there may be, exceptionally, coverage of the treatment indicated by the attending physician or dentist, provided that certain requirements are met.
