ATA/404/1998•Early resignation from health insurer after indirect premium increase
ATA/404/1998Tribunal de Justiça / Câmara Administrativa30 de jun. de 1998Dismissed
Extraído pela Omnilex
The case concerned the insured person’s attempt to leave her health insurer early after an indirect premium increase caused by a reduced discount linked to the deductible. The court held that an early resignation must also be recognized in such circumstances. However, because no new affiliation had yet taken place, the insured remained attached to the existing insurer until that new affiliation, and only subject to payment of outstanding premiums. The appeal or request was therefore dismissed in the result.
LAMal art. 7 para. 2; early termination of health insurance in case of indirect premium increase through a reduction of the deductible-related discount. The right to resign early is not limited to formally increased premiums; it also applies where the economic burden rises indirectly in a manner equivalent to a premium increase. Nevertheless, termination does not itself end the insurance relationship if no new affiliation has taken effect; continuity of affiliation persists until replacement coverage begins, and arrears may remain payable as a condition of release (consid. unspecified).
Descripteurs
ASSURANCE SOCIALE; AM; PRIME D'ASSURANCE; RESILIATION; AFFILIATION; ASSU
Normes
LAMAL.7 al.2
Résumé
Le droit de démissionner d'une caisse-maladie de manière anticipée doit être reconnu également lorsque la prime d'assurance augmente indirectement, par l'effet d'une diminution du taux de réduction lié à une franchise. En l'espèce, toutefois, aucune nouvelle affiliation n'ayant eu lieu, l'assurée reste attachée à sa caisse-maladie jusqu'à sa nouvelle affiliation, et sous condition du paiement des primes arriérées.
Extraído pela Omnilex
Whether an insured person may resign early from compulsory health insurance when the premium rises indirectly through a reduced deductible-related discount.
The right to resign early must also be recognized in such a situation.
An indirect premium increase produced by a change in the deductible discount has the same practical effect as a direct premium increase for the insured.
Whether the insured remained bound to the insurer despite the attempted change of insurer.
In the absence of a new affiliation, the insured remains attached to the current insurer until a new affiliation occurs, subject to payment of overdue premiums.
Termination alone does not end the insurance relationship if no replacement affiliation has taken effect; continuity of coverage and settlement of arrears remain required.
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