Quarta Turma afasta cobertura de fertilização in vitro com exclusão expressa no plano de saúde

Quarta Turma afasta cobertura de fertilização in vitro com exclusão expressa no plano de saúde

Para o colegiado, determinar cobertura obrigatória da fertilização in vitro pode trazer indesejável repercussão no equilíbrio econômico-financeiro dos planos, o que prejudicaria os segurados e a própria higidez do sistema de suplementação privada de assistência à saúde.

Fonte: STJ

Comentários: (0)

Reprodução: pixabay.com

​Por unanimidade, a Quarta Turma do Superior Tribunal de Justiça (STJ) decidiu que não é abusiva a negativa de cobertura, pelo plano de saúde, de tratamento de fertilização in vitro.

Para o colegiado, determinar cobertura obrigatória da fertilização in vitro pode trazer indesejável repercussão no equilíbrio econômico-financeiro dos planos, o que prejudicaria os segurados e a própria higidez do sistema de suplementação privada de assistência à saúde.

“A fertilização in vitro não possui cobertura obrigatória, de modo que, na hipótese de ausência de previsão contratual expressa, é impositivo o afastamento do dever de custeio do mencionado tratamento pela operadora do plano de saúde”, afirmou o relator, ministro Marco Buzzi.

Exclusã​​​o expressa

No caso julgado, o contrato continha cláusula que excluía expressamente o tratamento pleiteado pela beneficiária.

A controvérsia teve origem em ação ajuizada por usuária de plano que, em razão de problemas de saúde (endometriose), teve recomendação médica de tratamento para engravidar por meio da técnica de fertilização in vitro.

Em primeiro grau, o pedido foi julgado improcedente, mas o Tribunal de Justiça de São Paulo deu provimento ao recurso da mulher para obrigar o plano a custear o tratamento, sob o argumento de que é possível interpretação abrangente acerca do alcance do termo “planejamento familiar” contido na legislação para incluir a fertilização in vitro.

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