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Monthly fees increased by an average of 45% for those who turned 59 in 2012
The 59th birthday has become a recurring problem for health plan customers. This is when operators apply the most expensive adjustment to monthly rates. But the practice has become so abusive that the tendency to convict companies has increased in the judiciary, according to specialists interviewed by the column.
Due to allegations of abusive age adjustments, judges have condemned plans to keep or adjust the monthly rent at a reasonable level.
“Many contracts make a high adjustment at 59 years. Sometimes the monthly fee goes up to 130%”, underlines the lawyer Rafael Robba, specialist in health law and partner of Vilhena Silva Advogados.
Not all clients go to court when they turn 59 and find themselves cornered by abusive readjustments in health plans. Brazilian legislation only allows operators to adjust monthly rates by age group up to 59 years. That’s why it has become an era where customers are forced to opt out of health plans.
“Operators do not want the elderly in health plans, if we look at how contracts are drafted. They clearly create barriers for the elders not to continue with the plan. This ends up generating arguments in court,” explains Robba.
Because it selectively penalizes the elderly, this type of abusive readjustment is also considered a form of ageism, that is, ageism.
As can be seen from the section, the number of complaints submitted to ANS in which consumers reported having suffered some form of prejudice or differential treatment due to age in requests for assistance addressed to operators increased by 70%. This type of complaint was presented by 40 consumers in 2013, the beginning of the period analysed. But in 2022, age discrimination ended up being reported in 67 complaints against health plans.
When clients go to court, magistrates usually analyze the specifics of the contract and also the market average. By law, monthly rentals for customers 60 and older cannot cost six times the price for under-18s.
The problem is that there is no specific definition of abusive readjustment in legislation. Magistrates then usually use the average observed in the National Health Agency (ANS) tariff list as a parameter. According to the latest data available on this panel, plans increased by an average of 45% for those aged 59 and over in July of last year. Returns above this average are generally considered abusive by magistrates.
Before finding that the readjustment was abusive, judges usually also require that the plan contain actuarial studies justifying a higher-than-market price increase. Since not all firms present these studies, this also increases the possibility of a favorable judgment for the client, according to the lawyer.
“The judges have been more favorable to the consumer to counter abusive readjustments”, concludes Robba.
Source: Terra
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