Brasília – The Supreme Federal Court publishes its full ruling on coverage of treatments not included in the National Supplementary Health Agency’s list of mandatory procedures, establishing more restrictive and cumulative requirements for when private health plans must authorize therapies outside the official list. The court emphasizes that the decision aims to reinforce technical parameters, reduce legal uncertainty and preserve financial sustainability in the supplementary-health sector.

Under the ruling, coverage of “extra-list” treatments is only mandatory when all conditions are met: prescription by a qualified professional; no explicit refusal or pending review by ANS; absence of an adequate alternative therapy within the list; robust scientific evidence demonstrating efficacy and safety; and valid regulatory approval by Anvisa. The decision consolidates ANS’s role as the primary technical reference for defining coverage in private health plans.

Source: Futuro da Saúde