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The Minister of Health published the Medical Schemes Amendment Bill (MSAB) and the National Health Insurance Bill (NHIB) on 21 June 2018. This is a complex Bill of more than 70 pages and contains many proposed amendments to the Medical Schemes Act. Due to the technical and complex nature of the amendments, we will study the Bill very carefully, comment on the provisions and engage the relevant stakeholders.

At the briefing on 21 June, the Minister made reference to the following proposed amendments:

  • Co-payments will be abolished, and there will be regulation of provider payments.
  • Remuneration of brokers will change and be more transparent.
  • PMBs will be replaced by Comprehensive Service Benefits with greater emphasis on primary care.
  • New benefit options will be reviewed by the Registrar, and only approved if in the interest of the members.
  • It will be an offense to run a medical scheme type product without being registered as a medical scheme.
  • Central provider and beneficiary registries will be created.
  • Income cross-subsidisation will be introduced through income-related contributions.
  • Savings for using designated service providers must benefit members directly.
  • Underwriting such as Late Joiner Penalties and Waiting Periods will be adjusted.
  • Minimum education requirements will be introduced for Trustees and Principal Officers.

Discovery Health’s position is clear: “brokers play a fundamentally important role in advising medical scheme members and provide valuable services to medical schemes and their members. The absence of brokers would be highly detrimental to members and we do not believe that the absence of brokers would materially reduce costs for medical schemes (as implied by the Minister) as the services delivered by brokers are critical to the effective operation of medical schemes and would most likely need to be provided directly by schemes at their own cost.

The public now has an opportunity to comment on these Bills over the next three months. The Department of Health will then consider the public comments and incorporate these in a revised Bill. Depending on the nature of the comments, the Department could take three to nine months - or even longer - to make changes to the Bill.

After the Department of Health has reviewed the Bills, the Bills will be tabled at NEDLAC where business, labour, government and community representatives will debate the content and seek to develop consensus. This part of the process is likely to take longer than three months. On completion of the debates, the Minister can then formally introduce the Bill to Parliament, where Parliament will run its own public consultation process over a period of three to six months.

The Bill will then be voted on before it gets introduced in the National Council of provinces. It is therefore likely that the Bill will only be introduced to Parliament after next year’s elections and it is also important to note that about twelve Acts will need to be amended during the implementation of the NHI.

The Minister also made a presentation on the NHI Bill. The key objective of the Bill is to create a fund that will ultimately become the single public purchaser of healthcare. Efforts will be made to ensure sustainability. The Fund will only purchase from certified, accredited and contracted service providers.

The Bill has nine parts, and deals with the following:

  1. Establishment of the NHI Fund
  2. Right to health care
  3. The board of the fund
  4. The CEO
  5. Ministerial Committees
  6. General Provisions applicable to the operation of the fund
  7. Complaints and appeals
  8. Financial matters
  9. Miscellaneous

Momentum’s Health Solutions is excited about the opportunity to engage on these Bills and welcomes the opportunity to work towards an improved health system for all!

Kenneth Marion, chief operating officer of Bonitas, believes the abolishment of co-payments is also quite idealistic. This amendment would mean the full cost of healthcare would be covered by schemes. But Marion explains that in all instances in which co-payments arise, consumers have alternative options to take. For example, co-payments often apply to elective procedures or out-of-pocket payments for medicine if generics are available, and if a consumer receives healthcare from a service provider which has not been designated in terms of the rules of the scheme.

Marion also shared views on the proposed abolishment of brokers. "Brokers help alleviate some of this confusion by providing an independent evaluation of a person's specific circumstances, both from a financial and healthcare perspective," Marion said. Marion explained that from a servicing perspective, brokers are "invaluable", as they aid consumers in resolving their queries quickly and efficiently, and help educate them.

Jeremy Yatt, principal officer of Fedhealth commented that they are currently considering and reviewing the contents of these bills and will share their views in due course. “The changes suggested are so far-reaching however, that we cannot imagine them being implemented anytime soon”.

As always Fedhealth remains confident in the work we are doing to take good care of our family of members. “Brokers are an invaluable part of our team, and we can assure you of the Scheme’s ongoing support!

Simeka Health continues to keep a close eye on the developments of proposed amendments to ensure that you stay informed and up to date on developments within the industry.

Please be assured that none of the above will affect the service delivery from Simeka Health and we look forward to engaging with you in the next few months as we learn what the various Schemes are planning for 2019.

Please contact Simeka Health on our Client Care line at 0860 122 340 or email us at info@simekahealth.co.za.

 

 

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