Following the announcement that there will be a change to Regulation 8 of the Medical Schemes Act, which pertains to prescribed minimum benefits (PMBs), there have been several reactions.
The Council of Medical Schemes (CMS) has provided the following interpretation to the amendments made to Regulation 8 of the Medical Schemes Act:
· “It has not been substantively amended as far as its requirement to protect members from having to pay for the set of PMBs out of their pockets is concerned. This is clearly stated in sub-regulation (1) of the regulation which has not been amended,” stated the CMS.
· The NDOH amendment predominantly affects sub-regulation (2), this relates to the appointment of DSPs and medical schemes’ efforts to protect their members from service providers who may charge higher rates.
· This restriction of the amendment to sub-regulation (2) is defined not only by the inclusion of the new paragraph (c) as an addition to sub-regulation (2), but also by the linkage of paragraphs (b) and (c) by the word ‘and’.
· “The amendment defines the extent to which a scheme may be expected to pay if a member voluntarily uses a non-DSP, the limit being the cost of the specific service as stipulated in the National Health Reference Price List (NHRPL) of 2006 plus an annual inflation of consumer price index (CPI) for every subsequent year. This is an aspect that was previously not defined, i.e. a scheme could arbitrarily decide what the member co-payment should be under such circumstances,” noted the CMS.
Dr Jonathan Broomberg, Discovery Health CEO added: “Some commentators cited in recent media coverage have suggested that medical schemes will somehow use these draft regulations to ‘exploit’ their members and deprive them of benefits and necessary care. In our view, this commentary ignores the fact that schemes are simply a collective of their membership, and that scheme trustees act in the best interests of the membership. There is no reason for schemes to use the new regulations to act against their membership in any way. We therefore do not see this risk emerging, nor do we see these draft regulations as intending to compromise the care provided to scheme members.
“It is important to note that these regulations are in draft form and remain open for comment for three months before they will be finalised. It is very likely that they will be challenged by various parties, and that the process of implementation will be somewhat delayed. At this point, we therefore do not believe that our client schemes should be relying on any changes to current PMB provisions of the MSA in finalising their 2016 benefits and budgets.”
You can submit written comment on the amendments to the Director-General of Health (marked for the attention of the Director of Public Entities Governance and Management), at:
Private Bag X828
Pretoria
0001
To read the amendments, click here.