Medical schemes regulator to explain ‘puzzling move’ on low-cost plans
The medical schemes regulator is expected to brief the industry on Thursday on its shock announcement in 2019 that it intends to scrap low-cost benefit options (LCBOs) and health insurance products.
The Council for Medical Schemes (CMS) has invited health insurers, medical schemes and administrators to an “engagement session” to “unpack and deliberate on” the measures set out in circular 80 and a subsequent research note setting out its rationale in circular 82. Further meetings are planned with industry associations, bargaining council medical schemes and Cape Town stakeholders, said CMS registrar Sipho Kabane.
The CMS announced in December that it would stop granting exemptions to the Medical Schemes Act after March 2021, effectively putting an end to cheap primary health insurance products, as well as bargaining council medical schemes that offer pared-down benefits.
This directive, combined with the scrapping of the LCBOs, overturned a policy trajectory previously agreed to by the ministers of health and finance that aimed to safeguard consumers by drawing a clear distinction between medical schemes and health insurance products. The intention was to migrate health insurance products into closely regulated LCBOs, thus ensuring that consumers retained their cover.
Kabane said in December the CMS was concerned that products offering different levels of cover depending on what consumers could afford were at odds with the government’s plans for National Health Insurance.
The regulator’s move stunned the industry and caught the Treasury on the back foot. Kabane said the CMS had met Treasury officials on Tuesday and expected to have further talks after completing its industry consultations.
“The approach adopted by the CMS in circular 80 constitutes a departure from an ideology it has maintained for years. To say that it has surprised the industry would be an understatement,” said the SA Insurance Association’s health insurance forum chair, Sven Laurencik.
While the rationale behind the CMS’s “new” approach is contained in circular 82, the conclusions reached by the CMS and its motivation for scrapping LCBOs are not evident from the circular, said Laurencik.
Medshield is among the medical schemes that has had its plans to launch LCBOs scuppered by the regulator’s move.
“We are concerned by the CMS’s decisions and that this continued delay to allow schemes to launch affordable LCBO products means the existing barriers for South Africans to access quality private health care will remain for the foreseeable future, and therefore place greater reliance on an already overburdened public health sector,” said Medshield principal officer Thoneshan Naidoo.
Medshield had hoped to launch four LCBOs under the banner of its MediAlpha plan, ranging from R130 to R650 per month.
“It would have enabled access to high-quality private primary health care to millions of uncovered South Africans who have not been able to afford medical cover,” said Naidoo.
The Free Market Foundation said in a statement that the regulator’s move was puzzling.
“It is difficult to understand what the motive behind this move is, given that the CMS and the private sector have been working together to develop the LCBO for the past five years. Industry leaders are also none the wiser, since absolutely no stakeholder engagement preceded this shock move”, said Mike Settas, a member of the foundation’s health policy unit.
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