Pre-existing diseases or injuries prior medical examination in health plan contracts and STJ summary 609

Abstract

The constant exclusion of coverage in cases of diseases called preexistinggave rise to a new adequacy of rule, reinforced by STJ Precedent 609. Theemergence of a manifestation of consumer society has brought with it contractualinequalities, especially in adhesion contracts, such as the health insurance contract.Conflicts began to arise and, in order to adjust the current social situation andrebalance the contractual relationship, contractual clauses began to suffer limitations or extensions, many of them through state intervention through judicialization,imposing on contractors (beneficiary of the health plan) and for contractors (healthcare providers) certain rules that are independent of their real will. It is evidenced bythe analysis of legal norms and the summary, the need for pre-admission exams,which would end all doubts about the coverage of pre-existing diseases or injuries.This more modern and social interpretation in situations that occur in health insurancecontracts and its rules regulated by the Health Insurance Law and correspondingregulations of the National Supplementary Health Agency is what we will observe. Thestudy, conducted through documentary and literary review, aims to explore anddemonstrate the need to perform prior examinations to health insurance contracts.