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The Proposed Medical Schemes Amendment Bill – What you need to know

June 25, 2018

Health Minister, Dr Aaron Motsoaledi announced radical changes to the Medical Schemes Amendment Bill, to align it with the National Health Insurance Bill, in a media briefing on Friday (21 June 2018).  These developments promise to revolutionise the healthcare industry, and strongly indicate that you and I will be members of NHI by 2022.

The gazetted bills will be open for public comment for a period of three months.

On the National Health Insurance Bill, Dr Motsoaledi claimed that the implementation of NHI will solve two pressing issues currently facing the South African consumer:

  • The exorbitant costs of private healthcare, and
  • the inferior quality of care in the public system.

Whilst NHI is being phased in, the Health Minister envisages that the proposed amendments to the Medical Schemes Bill will provide financial relief to medical scheme members, allow for a smooth alignment with NHI and little or no disruption to the accessibility of healthcare.

The ten key proposed amendments discussed include:

Cessation of co-payment 
Dr Motsoaledi stated that ‘every cent charged’ to a member of medical scheme must be funded by the medical scheme, a proposal he wishes to assure ‘was well thought out’.

An end to the practice of using ‘brokers’ within the industry
Dr Motsoaledi questioned the need for brokers, given that members often don’t even know who their brokers are, and few make use of their services.

PMBs to be replaced by comprehensive service benefits 
Comprehensive service benefits will include Primary Health Care (PHC) like family planning, vaccination, screening and wellness services.

Restricting schemes from implementing scheme options 
These options will be restricted unless approved by the Registrar of the Council for Medical schemes.

Businesses not registered as medical schemes
Dr Motsoaledi will be clamping down on unregistered businesses carrying on the business of medical schemes, such as hospital cash-back plans.

A central beneficiary register 
A database will be created for identifying trends and assessing risks within medical schemes, to counteract the reluctance of medical schemes to share information with Government.

Income cross-subsidisation model
Based on the same approach as the NHI model, the rich should subsidise the poor. No further information on how this will be implemented has been provided yet.

Members benefit from savings
Dr Motsoaledi used the example of scheme requesting members to use designated service providers and stated that this saving should be passed back to members in the form of premium reductions.

Cancelled membership and waiting periods
The application of this amendment has various scenarios, most notably, medical schemes will not be able to impose any waiting periods in respect of any child.

Governance of medical schemes
This refers to minimum educational qualifications and expertise for Medical Aid Scheme CEOs and members of a Board of Trustees.

In addition, Dr Motsoaledi acknowledged the amount of money held in reserves as part of the statutory 25% solvency requirement for medical schemes. This is currently being reviewed by the Council for Medical Schemes with the view to having excess funds ‘released for the care of patients.’ The Minister also mentioned the publication of the Healthcare Market Inquiry provisional findings and recommendation report on 28 June 2018.

The overarching goal would seem to be to save the public money.

Abolishing co-payments was a dramatic and ostensibly positive opening statement, but consider income cross subsidisation, and we have to ask what the actual outcome is for a member of a medical scheme.

Whilst we can all agree that the cost of private healthcare needs to be reviewed, we also need to consider changing the industry responsibly and with careful consideration.

To drive down the cost of healthcare in South Africa successfully, the public and private sectors need to combine their intellectual resources and work together to provide workable solutions for all South Africans.

To access the full Medical Schemes amendment Bill and NHI Bill please visit You are welcome to contact us should you wish to clarify any of the changes or their implications.

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