Validity of newspaper notice on premium reduction practice

ATA/402/1997Tribunal de Justiça / Câmara Administrativa24 de jun. de 1997Dismissed

Extraído pela Omnilex

Resumo Omnilex

The dispute concerned a health insurer’s change in practice on premium reductions for insured persons aged 19–20 and, upon request, 20–25. The court held that the publication in the insurer’s newspaper was sufficient notice to insureds who had received it, because the information did not constitute an essential change to the general conditions. The insured’s challenge therefore failed.

Sumário Omnilex

Art. 61 al. 1 LAMal; communication of a change in premium-reduction practice to insured persons. Where the information published by a health insurer in its newspaper does not amount to an essential modification of the general conditions, such publication may constitute valid communication to insureds who have received a copy of that newspaper. The sufficiency of notice is assessed functionally, in light of the nature and significance of the change; a mere adjustment of administrative practice does not require a formal individual notification if the insureds are otherwise duly informed.

Texto completo

Descripteurs

ASSURANCE SOCIALE; AM; REDUCTION(EN GENERAL); REDUCTION DES PRIMES(PERCEPTION DES PRIMES); ASSUREUR; ENFANT; PROCEDURE ADMINISTRATIVE; CHANGEMENT DE PRATIQUE; ERREUR DE CALCUL; ASSU

Normes

LAMAL.61 al.1

Résumé

Dans la mesure où les informations parues dans le journal d'une caisse ne constituent pas une modificatioin essentielle des conditions générales, elles doivent être considérées comme une communication faite valablement aux assurés qui en ont reçu un exemplaire (réduction automatique des primes pour les 19-20 ans et, sur demande, pour les 20-25 ans).

Palavras-chave

social insurancehealth insurancepremium reductionnoticechange of practiceinsured personscommunicationadministrative procedure

Extraído pela Omnilex

Questões jurídicas principais extraídas pela Omnilex

Questão jurídica principal

Whether a newspaper notice by the insurer constituted valid communication to insured persons about the changed premium-reduction practice.

Decisão extraída

The notice was a valid communication to insured persons who had received the insurer’s newspaper; it did not amount to an essential change of the general conditions.

Fundamentação extraída

Because the information published in the insurer’s newspaper did not modify the general conditions in an essential way, publication in that medium was sufficient notice to the insureds who had been sent a copy.

Validity of newspaper notice on premium reduction practiceGerado por IA