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Medical schemes appeal CMS scrapping of low-cost benefit packages

The Board of Healthcare Funders (BHF) and the Health Funders Association (HFA) have challenged the Council for Medical Schemes (CMS) shock move last year to scrap primary health insurance and low-cost benefit packages.

The two biggest associations have lodged formal appeals, reports Business Day. In December, the CMS issued a circular (Circular 80) that effectively overturned an agreement that was agreed to by health and finance ministers that allowed primary health care plans to remain in place until a new low-cost benefit regime had been implemented.

The report says it has now emerged that the Board of Healthcare Funders (BHF) and the Health Funders Association (HFA) have challenged circular 80 with the CMS appeals board. Both associations represent medical schemes and administrators, and each holds a dominant player: South Africa’s biggest restricted scheme, the Government Employees Medical Scheme (Gems) belongs to the BHF, while South Africa’s biggest open scheme, Discovery Health Medical Scheme (DHMS) belongs to the HFA.

BHF head of research Clinton Murove said the organisation lodged an appeal with the CMS appeal board in terms of section 50 of the Medical Schemes Act, but does not yet have a date for a hearing. Given the urgency of the matter, the BHF was also preparing to take legal action, he said.

The report says the CMS declined to answer questions or indicate how many appeals it has received.

The HFA has lodged a joint appeal with DHMS, its administrator Discovery Health, four other medical schemes (Bankmed, Fedhealth, Profmed and LA Health) and two other administrators (Momentum Health and PPS Healthcare).

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