- Início
- Livros E Revistas
- Contratos de Planos de Saúde
- Anexo. Legislações Específicas Sobre Os Planos de Saúde
Resolução do Conselho de Saúde Suplementar - CONSU nº 13 de 3 de novembro de 1998
Autor | Josiane Araújo Gomes |
Ocupação do Autor | Mestra em Direito Público pela Universidade Federal de Uberlândia (UFU). Especialista em Direito das Famílias pela Universidade Federal de Uberlândia (UFU). Servidora do Tribunal de Justiça do Estado de Minas Gerais (TJMG) |
Páginas | 338-339 |
Page 338
Dispõe sobre a cobertura do atendimento nos casos de urgência e emergência.
O Presidente do Conselho de Saúde Suplementar - CONSU, instituído pela Lei nº 9.656, de 03 de junho de 1998, no uso de suas atribuições legais e regimentais e de acordo com a competência normativa que lhe foi conferida para dispor sobre regulamentação do regime de contratação e prestação de serviços de saúde suplementar e,
RESOLVE:
Art. 1º A cobertura dos procedimentos de emergência e urgência de que trata o art.35D1, da Lei nº 9.656/98, que implicar em risco imediato de vida ou de lesões irreparáveis para o paciente, incluindo os resultantes de acidentes pessoais ou de complicações no processo gestacional, deverá reger-se pela garantia da atenção e atuação no sentido da preservação da vida, órgãos e funções, variando, a partir daí, de acordo com a segmentação de cobertura a qual o contrato esteja adscrito.
Art. 2º O plano ambulatorial deverá garantir cobertura de urgência e emergência,limitada até as primeiras 12 (doze) horas do atendimento.
Parágrafo único. Quando necessária, para a continuidade do atendimento de urgência e emergência, a realização de procedimentos exclusivos da cobertura hospitalar, ainda que na mesma unidade prestadora de serviços e em tempo menor que 12 (doze) horas, a cobertura cessará, sendo que a responsabilidade financeira, a partir da necessidade de internação, passará a ser do contratante, não cabendo ônus à operadora.
Art. 3º Os contratos de plano hospitalar devem oferecer cobertura aos atendimentos de urgência e emergência que evoluírem para internação, desde a admissão do paciente até a sua alta ou que sejam necessários à preservação da vida, órgãos e funções.
§ 1º. No plano ou seguro do segmento hospitalar, quando o atendimento de emergência for efetuado no decorrer dos períodos de carência, este deverá abranger cobertura igualmente àquela fixada para o plano ou seguro do segmento ambulatorial, não garantindo, portanto, cobertura para internação.
§ 2º. No plano ou seguro do segmento hospitalar, o atendimento de urgência decorrente de acidente pessoal, será garantido, sem restrições, após decorridas 24 (vinte e quatro) horas da vigência do contrato.
§ 3º. Nos casos em que a atenção não venha a se caracterizar como própria do plano hospitalar, ou como de risco de vida, ou ainda, de lesões irreparáveis, não haverá a obrigatoriedade de cobertura por parte da operadora.
Art. 4º Os contratos de plano hospitalar, com ou sem...
Para continuar a ler
PEÇA SUA AVALIAÇÃO- Contratos de Planos de Saúde
- Anexo. Legislações específicas sobre os Planos de Saúde
- Lei nº 9.656, de 3 de junho de 1998
- Resolução do Conselho de Saúde Suplementar - CONSU nº 06 de 3 de novembro de 1998
- Resolução do Conselho de Saúde Suplementar - CONSU nº 13 de 3 de novembro de 1998
- Resolução de Diretoria Colegiada - RDC nº 39, de 27 de outubro de 2000
- Resolução Normativa - RN nº 19, de 11 de dezembro de 2002
- Resolução Normativa - RN nº 63 de, 22 de dezembro de 2003
- Resolução Normativa - RN nº 124, de 30 de março de 2006
- Resolução Normativa - RN nº 162, de 17 de outubro de 2007
- Resolução Normativa - RN nº 171, de 29 de abril de 2008
- Resolução Normativa - RN nº 172, de 8 de julho de 2008
- Resolução Normativa - RN nº 186, de 14 de janeiro de 2009
- Resolução Normativa - RN nº 195, de 14 de julho de 2009
- Resolução Normativa - RN nº 196, de 14 de julho de 2009
- Resolução Normativa - RN nº 363, de 11 de dezembro de 2014
- Resolução Normativa - RN nº 387, de 28 de outubro de 2015
- Referências
- Índice Alfab ético Remissivo
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