NHI Act: Keep your medical scheme membership

The medical scheme regulator, as well as medical schemes, are calling on medical scheme members to keep their membership although the president signed the NHI Act into law this week. The NHI Act in its current form bans medical schemes for procedures that will be covered by the National Health Insurance.

The Council for Medical Schemes (CMS) says it welcomes the signing of the NHI Act and regards it as a significant development towards addressing the country’s fragmented health system and ensuring universal health coverage for all.

“We acknowledge the various debates, objections and threats of legal challenges, including support for the NHI Act. However, as the regulator, we would appeal to all sections of medical schemes’ role players and members not to panic or cause widespread speculation.”

The CMS says it understands that the NHI Act will take effect on a date fixed by the president by proclamation in the Government Gazette and subject to section 57 of the Act, different dates may be fixed for different sections to come into effect.

“Section 57 of the Act states that NHI will be phased in gradually using a progressive and programmatic approach based on financial resource availability.”

The CMS says against this background, the Medical Schemes Act and its regulations still applies and the CMS calls on all members of medical schemes not to abandon or cancel their membership. “We assure the industry that we will continue to engage and offer support to the private health-care industry on any regulatory risks identified.”

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Business as usual for medical schemes

The Board of Healthcare Funders (BHF) has also urged members of medical schemes to keep their membership, saying while the president has signed the NHI Act into law, it does not mean South Africans should cancel their medical aid contracts.

“The signing does not immediately impact scheme membership. It is business as usual and medical aid schemes will continue to enable access to health services.”

The BHF also points out that the medical schemes industry continues as it did before the president assented to the NHI Act.

“The president signing the NHI Act means that the NHI is now law, but it does not mean that the entire Act immediately becomes operational. By cancelling their medical aid, South Africans will leave themselves vulnerable and they will not be covered in the unfortunate event of a medical emergency.”

The BHF says as an organisation dedicated to strengthening the health system and advancing the interests of the health citizen, it will be challenging the sections of the NHIA that reduce the role of medical schemes as it represents numerous medical aid schemes.

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BHF planning legal steps to challenge NHI Act

“We do not believe the NHI Act in its current form is sufficient to achieve universal health coverage. More specifically, the BHF will be instituting legal proceedings to challenge, amongst others, section 33 of the NHI Act, which is unconstitutional and unlawful, with a view to ensuring the sustainability of the medical schemes industry going forward.”

The BHF says its core aim is to ensure the sustainability of the healthcare sector, including enabling medical schemes, managed care organisations and administrators to continue providing accessible, affordable and quality healthcare to their medical scheme beneficiaries.

“In the long term, the NHI Act aims to reduce medical schemes to a complementary health care funding role. BHF is of the strong view that medical aid is a national asset and should play a significant role in creating access to health care services now and in the future.”