Medical schemes fight regulator’s move to scrap low-cost benefits

The medical schemes industry is fighting back against the regulator’s shock move last year to scrap primary health insurance and low-cost benefit packages, with its two biggest associations lodging formal appeals.

It has now emerged that the Board of Healthcare Funders and the Health Funders Association have challenged circular 80 with the CMS appeals board. Both associations represent medical schemes and administrators, and each holds a dominant player: SA’s biggest restricted scheme, the Government Employees Medical Scheme belongs to the BHF, while SA’s biggest open scheme, Discovery Health Medical Scheme belongs to the HFA.

Discovery Health CEO Ryan Noach said circular 80 would strip more than 500,000 South Africans of affordable access to private health care. Primary health insurance premiums cost a fraction of traditional medical scheme cover, as they provide fewer benefits, and are often heavily subsidised by employers. Discovery Life, which holds the licence for a primary care product, submitted its own appeal in December, he said.

These low cost plans do not cover hospilisation in Private as patients have exorbitant co-payments they cannot afford. Patients then end up being transferred to government hospitals. So they get no bang for their buck.

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