READJUSTMENT IN HEALTH PLANS

Abstract

The research addresses Law 9,656/1998, which regulates health plans in Brazil, and the role of the National Supplementary Health Agency (ANS) in regulating prices. The study highlights the mismatch between the tariff values and the services provided, as well as the adjustments based on the variation in the costs of medical and hospital procedures and the age group of the beneficiaries. The central problem is the lack of government supervision, which allows abusive adjustments and does not guarantee the quality of services, resulting in contractual imbalance. The objectives include explaining the contractual relationship between beneficiaries and operators, discussing the contractual modalities, exposing the adjustment rates applied, identifying the regulation of adjustments and analyzing the possibility of state intervention in abusive contractual relationships. The research uses the analytical and documentary method to analyze the relevant legislation, the Civil Code and the Consumer Code, demonstrating abusiveness in relationships between companies and beneficiaries of private health plans. The research results indicate that adjustments to health plans are often abusive, especially penalizing elderly consumers, who are more vulnerable. The legal analysis revealed that current legislation, although it establishes rules for adjustments, is often inadequate to protect beneficiaries against abusive practices. It is concluded that there is an urgent need for greater supervision and state intervention to ensure that adjustments are fair and proportional to the service provided, thus avoiding contractual imbalance and guaranteeing the protection of consumer rights.