Ina Opperman There is good news for consumers whose medical schemes force them to use specific doctors, pharmacies and other medical service providers. Picture: Jacques Nelles
No more dedicated service providers for medical schemes will be allowed, according to a notice the Council for Medical Schemes (CMS) published recently in the
Government Gazette in terms of the Medical Schemes Act.
The notice declares the practices of some medical schemes to select designated healthcare providers as irregular or undesirable.
Dedicated service providers
Chapter 3 of the act allows medical schemes to select healthcare providers as dedicated service providers to diagnose, treat, and care for its members regarding prescribed minimum benefit conditions, but according to information passed on to the Registrar of Medical Schemes, some schemes:
South Africa prepares for next phase of the NHI – which includes ‘mandatory pre-payment’
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The Council for Medical Schemes (CMS) says that the government’s planned National Health Insurance is in full development, with plans to move to phase 3 of the programme from next year.
In its 2021/2022 annual performance plan, the CMS said that phase 3 will include mandatory pre-payment of the new scheme, contracting for accredited private hospital and specialist services, and finalisation and implementation of the NHI Act.
The NHI Bill was presented to and approved by cabinet in July 2019, and has been presented to parliament’s health portfolio committee.
Tuesday 4 May 2021 - 7:03pm
File: The medical aid administrator, which is in charge of Discovery, has made its submission at the Council for Medical Schemes.
JOHANNESBURG - Medical aid members may no longer have to worry about forking out high-co-payments if they do not use the network of doctors assigned by their schemes.
In a new notice in Government Gazette, the Council for Medical Schemes has declared this practice undesirable .
Tito Mboweni
NATIONAL NEWS - Finance Minister Tito Mboweni has published the Annual Policy Benefit Escalations regarding the Demarcation Regulations, regulated under section 72 of the Long-term Insurance Act and section 70 of the Short-term Insurance.
In a statement on Wednesday, the Treasury said the regulations specify which types of contracts are regulated under the Long-term Insurance Act (LTIA) and the Short-term Insurance Act (STIA) as health policies, and accident and health policies, respectively, and accordingly are excluded from the Medical Schemes Act.
“Regulation 7.2(2) of the Regulations provides that all amounts referred to in sub-regulation (1) escalate annually, from the effective date, by the consumer price index (CPI) annual inflation rate published by Statistics South Africa,” read the statement.
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