To ensure member protection through continued access to quality healthcare, the Council for Medical Schemes (CMS) regulator has encouraged medical schemes to assist vulnerable members who cannot pay contributions due to loss of income as a result of the coronavirus pandemic and subsequent lockdown.
Registrar Dr Sipho Kabane has suggested in a circular released yesterday that schemes consider giving members a premium holiday for three months if necessary where certain conditions are met.
“Schemes should investigate all disruptions to member contributions on a case by case basis and determine the merits thereof, before suspension or termination of membership,” he said, adding that where a member had accumulated sufficient savings in their Personal Medical Savings Account (PMSA) for a specific period, it would be in the public interest, to grant medical schemes exemptions from complying with their registered rules to use their savings to offset member contributions.
On the issue of Small, Medium and Micro-Sized Enterprises (SMMEs) seeking financial relief from medical schemes to protect their employees’ membership cover, Kabana said they should make a case to their respective medical schemes, demonstrating the financial impact caused by the lockdown due to the COVID-19 pandemic: “Consideration must be given to SMME’s ability to financially recover and to repay the medical scheme post the lockdown period.”
It was also noted in the circular that to prevent the possible exploitation of patients as a result of the COVID-19 pandemic, the CMS is facilitating an industry-wide engagement to develop a price and tariff negotiations framework: “In this initiative,” said Kabane, “the CMS is working with industry associations such as the Board of Healthcare Funders (BHF) and Health Funders Association (HFA), with the support of the National Department of Health. CMS’ role is to ensure that negotiations will benefit all medical scheme members.”
SOURCE: Council for Medical Schemes communications