REFLECTIONS ON THE DUTY TO REIMBURSE THE SERVICES PROVIDED BY THE SUS IN FAVOR OF BENEFICIARIES OF THE SUPPLEMENTARY HEALTH SYSTEM IN BRAZIL Sérgio Zagarino Júnior, Rodrigo dos Santos Dias, Luciano Pereira de Souza

Abstract

Article 32 of Law 9.656 / 98, which regulates the supplementary health sector in Brazil, requires that health plan operators promote reimbursement to the Unified Health System due to the services provided with contractual forecasts of beneficiaries of the plans carried out by the public network, according to the norms defined by the ANS National Health Agency. The Federal Supreme Court recently in the judgment of the Direct Action of Unconstitutionality (ADI) 1931 and of RE 597064 pacified the discussion on constitutionality on the subject. Currently, the reimbursement is made through an administrative procedure – Electronic Reimbursement Protocol to SUS - PERSUS, based on the National Equivalent Procedural Table - TUNEP. The paper sought to examine the STF's decision regarding the obligation to pay compensation, based on the principle of prohibiting unjust enrichment, as well as to present some of the main issues involving this legal obligation, such as the procedures and legal criteria for valuation and reimbursement of these services provided by the public network.