Health plans at 59: the last age-based increase and how to spot an abusive adjustment

Many people are alarmed by their health plan bill after a birthday. For plans signed on or after January 1, 2004, the rule is clear: the last age-based increase happens at 59. After that, the monthly premium can no longer rise because of age.

Where this rule comes from

Brazil's Statute of the Elderly Person (Law 10,741/2003, art. 15, § 3) prohibits health plans from charging older people different amounts solely because of their age. To give effect to this protection, the National Supplementary Health Agency (ANS) created rules for age-band adjustments. Today these rules are set out in Normative Resolution No. 563 of December 15, 2022, which replaced the former Normative Resolution No. 63/2003.

The 10 age bands

In plans signed on or after January 1, 2004, an age-based increase may only occur when the beneficiary moves into each of these bands:

• 0 to 18 years
• 19 to 23 years
• 24 to 28 years
• 29 to 33 years
• 34 to 38 years
• 39 to 43 years
• 44 to 48 years
• 49 to 53 years
• 54 to 58 years
• 59 years or older

The limits the insurer must respect

• The price of the last band (59 or older) cannot be more than six times the price of the first band (0 to 18).
• The sum of the increases between the 7th and 10th bands cannot exceed the sum of the increases between the 1st and 7th bands. This calculation follows its own mathematical formula, not a simple sum of percentages.
• The percentage for each band must be written in the contract.

After 59, does the plan never increase again?

It does not increase because of age. But the annual adjustment still exists, and it is something different: it follows the rise in healthcare costs. For individual and family plans, the annual cap is set by the ANS. For group plans, it follows its own rules and is generally negotiated between the insurer and the contracting company or entity.

What about plans signed before 2004?

The rules are different. For plans signed between 1999 and 2003, Law 9,656/1998 and CONSU Resolution No. 6/1998 apply, with seven age bands. In these contracts, the law prohibits age-based increases for people over 60 who have been in the same plan for more than 10 years (Law 9,656/1998, art. 15, sole paragraph). For contracts signed before 1999 that were not adapted to the law, the contract terms apply, always in line with the Consumer Protection Code.

When an age-based increase may be abusive

Brazil's Superior Court of Justice (STJ), in Theme 952, held that an age-band adjustment is valid only if it is provided for in the contract, follows the ANS rules, and does not use excessive or technically unjustified percentages that place an undue burden on the consumer or discriminate against older people. In Theme 1,016, the STJ applied these criteria to group plans as well. Some warning signs:

• a very high increase on turning 59;
• a contract that does not state the percentage for each band;
• an age-based increase after 59 in a plan signed on or after January 1, 2004;
• a last-band price more than six times that of the first band.

What to do if the increase seems abusive

• Gather the contract, the bills and the insurer's letters.
• Ask the insurer, in writing, for the table with the percentage for each age band.
• File a complaint with the ANS through Disque ANS (0800 701 9656) or the gov.br/ans website.
• If the problem persists, you may ask the courts to review the adjustment and order a refund of any overpayment. The limitation period for this claim is generally three years (STJ, Theme 610).

How our team can help

We review the contract and the bills, check whether the percentages comply with the ANS rules and the STJ case law, monitor the complaint filed with the ANS and, when necessary, handle the lawsuit seeking review of the adjustment. Each case requires an individual review of the documents.

Sources: Law 10,741/2003 (Statute of the Elderly Person), art. 15, § 3; Law 9,656/1998, art. 15; ANS Normative Resolution No. 563/2022; CONSU Resolution No. 6/1998; ANS, Monthly Fee Adjustment Guide (2025); STJ, Themes 610, 952 and 1,016.
© 2026 Diego Amâncio Dias. Original text. Reproduction is permitted with credit to the source.