Introduction

The regulations regarding travel insurance have been under discussion for over a year due to the Superintendence of Private Insurance's (SUSEP) efforts to promote public consultations in order to:

  • guarantee contracted coverage;
  • give consumers more options; and
  • provide consumers with ample travel insurance coverage.

Therefore, although the enactment of National Private Insurance Council Resolution 315/2014 came as no surprise, it has created significant changes in the market.

Resolution 315

Before Resolution 315 came into effect, medical and hospital expenses were not covered under insurance, but were offered as assistance services, which SUSEP did not regulate. This generated discussion regarding the practice whereby several assistance companies would jointly offer products with travel insurance and not always inform consumers about the full exent of the coverage.

Under Resolution 315, the reimbursement of medical and hospital expenses is covered under insurance and may be offered only by insurance companies or their agents. Further, Articles 21, 22 and 23 of Resolution 315 specifically state as follows:

  • Travel insurance may be commercialised only by authorised insurers or their agents, subject to SUSEP's oversight (for further details please see "Insurance agency in Brazil").
  • Travel agencies, passenger transportation companies, credit card operators and assistance companies cannot act as sponsors of group policies, except in cases of true sponsorship (eg, when they sponsor policies on behalf of their own employees).
  • The sale of assistance services with insurance characteristics is forbidden.
  • The sale of travel insurance as an ancillary product to assistance services is forbidden.
  • Insurance companies may contract assistance service providers to provide assistance services under travel insurance policies; however, the insurer is jointly liable for the services rendered by the assistance service providers.

Additionally, Resolution 315 provides for new mandatory travel insurance coverage.

Mandatory coverage

Previously, travel insurance had to cover only death and permanent disability. Under Resolution 315, travel insurance must now cover at least one of the following:

  • medical, hospital or dental expenses (either within the Brazilian national territory or abroad);
  • the transfer of the body of a deceased insured back to his or her country of origin;
  • the costs associated with transporting a passenger if he or she is in no condition to be transported by regular means;
  • the transfer or removal of a passenger to a clinic or medical facility;
  • life insurance, paid to beneficiaries in case of natural causes or accidents; or
  • total or partial permanent disabilities.

Further, travel insurance that covers travel abroad must cover the following:

  • medical, hospital or dental expenses (either within the Brazilian national territory or abroad);
  • the transfer of the body of a deceased insured back to his or her country of origin;
  • the costs associated with transporting a passenger if he or she is in no condition to be transported by regular means; and
  • total or partial permanent disabilities.

Under Resolution 315, coverage for medical, hospital and dental expenses must also cover episodes caused by pre-existing conditions or chronic diseases whenever such episodes are considered urgent or an emergency.

Industry concerns

While the above provisions aim to provide insured with more security and better care during travel, insurers are concerned about the costs and risks involved; the sector in general expects to experience severe price increases. Insurers are particularly concerned about Article 8, which states that the maximum indemnification limits for each type of coverage must be compatible with those practised by the insurance or service sector at the destination of the insured.

Another concern relates to Article 20, which reads: "Insurance companies are forbidden from requiring prior communication for coverages which allow exclusively for the reimbursement of expenses resulting from an insured event."

Previously, a person who suffered an insured event abroad had to notify the insurer whenever he or she wanted to use his or her travel insurance policy and could use the policy only once the insurer had approved the costs and the facility that would render the necessary services. This gave insurers control over the costs incurred under travel insurance policies and helped to regulate insured events more closely.

Now, however, consumers need not notify insurance companies whenever they suffer an insured event and may turn to the closest medical facility for assistance. However, until SUSEP or the courts establish otherwise, the burden of proof regarding the insured event will rest mainly with the consumer. In light of this, several entities are already recommending that consumers take photos, copy medical forms and the like to ensure that they can petition for their rights before consumer protection organisations or the courts in the event that they are denied coverage.

Marta Viegas

Juliana Mattar

This article was first published by the International Law Office, a premium online legal update service for major companies and law firms worldwide. Register for a free subscription.