Anban Pillay. Picture: FINANCIAL MAIL/ROBERT TSHABALALA
Anban Pillay. Picture: FINANCIAL MAIL/ROBERT TSHABALALA

The details of the benefits that medical schemes will be permitted to provide under National Health Insurance (NHI) will be determined by the sector’s regulator, the Council for Medical Schemes (CMS), a senior government official said on Wednesday.

The future role of medical schemes is one of the burning questions about the government’s plans for implementing universal health coverage, which it calls NHI.

“What we have done is propose that the registrar at the CMS make clear which services are covered by NHI and which are not, so there is a clear sense of what medical schemes will be able to cover. And they will revise it on a regular basis as the NHI benefits expand or change,” the health department’s deputy director-general for NHI, Anban Pillay, told delegates to the Board of Healthcare Funders of Southern Africa (BHF) annual conference, which took place in Cape Town this week.

The BHF represents medical schemes and their administrators, and its annual conference is a key industry gathering.

Medical schemes will remain voluntary and will be restricted to providing “complementary” cover, in line with the policy position set out in the NHI White Paper, said Pillay.

When asked why medical schemes could not cover the same benefits as those offered under NHI, he said it would be inappropriate for the state to legitimise buying cover for services it covered. “If the state covers you going to a private GP, why would you pay again?” he asked.

He said the NHI Bill, which is expected to be tabled in parliament within the next few weeks, will not contain details about the benefits covered under the NHI, or those that medical schemes will be permitted to cover. Details such as these will be left to regulations, he said.

“You would not want to write the package in the bill, as it would cause problems for medical schemes in the short and long term,” he said. The services offered under the NHI will evolve over time, he said.

The cabinet has asked health minister Zweli Mkhize to provide a detailed implementation plan, which is currently being worked on, he said. The National Treasury is finalising a financing paper, which is likely to be published at about the time the bill is released for public comment by parliament.

Said Pillay, the bill will be processed by both houses of parliament, which each provide opportunities for the public to have their say. 

kahnt@businesslive.co.za