Nathália Guedes Brum
Lawyer at Marcos Martins Advogados
In a recent decision, the Third Panel of the Superior Court of Justice (STJ) ruled that the minimum payment clause in a group health plan contract was invalid, as it was abusive and overly burdensome for the stipulating party (service contractor), in exchange for an exaggerated advantage for the operator.
This is a contract termination action with a declaration of unenforceability filed by an airport services company against the health plan operator (stipulator), due to the abusive price adjustment applied to the group health plan and the invalidity of the contractual minimum charge clause.
The lawsuit was upheld and the health plan operator filed a special appeal asking for the Court of Justice’s decision to be overturned, declaring the contractual minimum charge clause invalid and applying the Consumer Protection Code to the specific case.
Justice Nancy Andrighi, who reported the appeal to the STJ, explained that the purpose of the minimum charge clause is to avoid economic and financial imbalance in the collective health care contract.
In the specific case, there was a loss of 354 beneficiaries after the application of the contractual readjustment agreed between the parties, causing a strong impact on the economic-financial situation of the contract, which led the operator to demand compliance with the minimum payment collection clause corresponding to 160 beneficiaries by the contractor.
From this perspective, the Rapporteur pointed out that “the minimum collection clause, which, in theory, would serve to correct the contractual imbalance and allow the agreement to be maintained, has itself become a factor of excessive onerousness for the stipulator and an exaggerated advantage for the operator, which benefits from receiving amounts corresponding to more than 60% of the active beneficiaries, without having the obligation to provide the corresponding service”.
On the other hand, the judge ruled that the Consumer Protection Code is inapplicable in a case between a stipulator and a health insurance provider, except when the stipulator is vulnerable to the provider.
Thus, the Third Panel of the STJ unanimously heard the special appeal in part, in order to rule out the application of the Consumer Protection Code in the specific case, and upheld the decision of the São Paulo court which declared the minimum payment clause in the collective health plan contract invalid.
REsp nº 1.830.065 – SP (2019/0229147-1)
REPORTER: Justice NANCY ANDRIGHI – THIRD COURT
JUDGMENT: 17/11/2020
Source:
STJ. Available at:
https://www.stj.jus.br/sites/portalp/Paginas/Comunicacao/Noticias/12022021-Onerosidade-excessiva-invalida-exigencia-de-pagamento-minimo-em-plano-de-saude-coletivo.aspx Accessed on: Feb. 16, 2021.
