The Council for Medical Schemes (CMS) plans to apply for a reconsideration of the dismissal of its appeal against a High Court directive to provide the Board of Healthcare Funders (BHF) with documents on low-cost benefit options.
The court told the regulator it had no reasonable prospect of success, reports BusinessLIVE.
Low-cost benefit options (LCBO) may be offered by schemes only if they are granted an exemption to the Medical Schemes Act by the CMS.
Supporters of the option believe these could provide primary healthcare cover for millions of low-income workers who cannot afford traditional medical scheme options offering more benefits.
“While this legal outcome is a victory for the BHF, it is essential to underscore our dissatisfaction with the apparent delay tactics employed throughout this process. These delays hinder the …implementation of affordable medical aid options,” said BHF head of research Charlton Murove.
The appeal court decision on 18 December is part of a legal tussle between the BHF and CMS, which started when the association took the regulator to court in 2022 after accusing it of stalling the implementation of LCBOs. The CMS began developing a regulatory framework for LCBOs in 2015 but submitted its final report to Health Minister Joe Phaahla only in November 2023.
The BHF alleges the CMS refused to consider new exemption applications from medical schemes while it developed the framework, yet continued to allow a closed group of health insurers to continue selling primary healthcare cover products that effectively do the same thing.
The court had been asked by the BHF to set aside the CMS’ latest extension to the exemption granted to health insurers; its moratorium on medical schemes offering LCBOs; and its refusal to consider exemption applications from schemes wishing to do so, pending the framework’s finalisation.
To supplement its argument, the BHF asked the CMS to provide all of its records on LCBOs.
Dissatisfied with the CMS response, the BHF obtained a High Court order in July last year compelling the regulator and Health Minister to hand over the full record of their decisions on LCBOs.
Contempt of court proceedings were launched against both parties when the documents were not produced.
The Health Minister settled with the BHF and provided the records, but the CMS fought back, taking the matter to the appeal court. Its application for leave to appeal was heard on 13 December and dismissed with costs.
CMS spokesperson Stephen Monamodi said the regulator is applying for a reconsideration of the dismissal of its appeal.
BusinessLIVE article – Regulator rebuffed in low-cost medical cover case (Restricted access)
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