The understanding of the Court of Justice of São Paulo regarding the maintenance of dependents of the deceased holder in collective health plans

Abstract

According to the summary understanding of the ANS (Summary 13/2010), the death of the holder of an individual/family health plan does not terminate the contract, and the dependent beneficiaries are entitled to maintain the plan under the contracted terms and as long as contractual obligations are assumed. This right applies even after the expiry of the remission clause period. Because the aforementioned summary is expressed in relation to individual/family plans, operators do not grant the right of permanence to dependent beneficiaries (of deceased holders) of collective, corporate or membership health plans, requiring such users to seek help from the judiciary. The present work aimed to verify the understanding of the Court of Justice of São Paulo through research with an exploratory, descriptive and inductive method for data collection and analysis of rulings, as well as bibliographic and documentary research, using logical reasoning to interpret the sources normative and doctrinal. 38 (thirty-eight) judgments handed down between 2012 and 2024 were analyzed. In only 7 (seven) of the cases did the Court deny the beneficiaries the right to maintenance, these understandings being given before 2014, as there was no legal basis for doing so.  The only judge that denied maintenance after 2014 used STJ Theme 989 as justification. The 31 (thirty) and one judgments that granted maintenance used, by analogy, ANS Summary 13, consumerist principles and other protective legislation such as the Statute of the Elderly. In our opinion, the Court of Justice of the State of São Paulo is allowing dignified and equal treatment for consumers, even because there will be continued payment of the plan by the beneficiary himself, without any obstacle to the continuation of the contract.