STJ begins to judge whether health insurance should pay for IVF

The Supreme Court of Justice (STJ) has begun ruling on whether health plans are obligated to pay for IVF procedures. Only the operation’s rapporteur, Marco Pozzi, voted on Wednesday (22) and the analysis was suspended after an opinion was requested.

For the Minister, “except for an express contractual provision,” the HMOs are not obligated to bear the costs of treatment. Buzzi recognizes that cost requirements, in the blanket interpretation of family planning, will affect the economic and financial balance of health plan contracts.

The Health Insurance Act (9656/98) excludes IVF from the list of health care plans reference. Therefore, according to the minister, it does not make sense “that the medical procedure for IVF is optional coverage and that in vitro fertilization, which has complex and expensive characteristics, has mandatory coverage.”

The minister’s thesis does not contradict another thesis he previously defended in court. The third and fourth teams of STJ, specializing in private law, have adopted the position in favor of operators excluding the transaction from mandatory coverage.

The processes are on the agenda of the second section of STJ in a frequent appeal, which means that the prevailing understanding must be applied in all courts in the country.