Reminder of request for comment: Council for Medical Schemes Discussion Document on the Development of Low Cost Benefit Options and and Analysis of Medical Scheme Consolidation (29 March 2019)

In the SAMA Newsletter on 5 April 2019, we communicated a request for membership for comments on the Council for Medical Schemes (CMS) Circular 28 of 2019, which updates stakeholders on two developing issues:

• The Discussion Document on Development of Low Cost Benefit Options (LCBOs) within the Medical Schemes Industry, and
• The analysis of Small Medical Schemes (<6 000) members to contribute to the Consolidation framework which the CMS plans to implement.

Public comments on these two important policy documents are due to the CMS on 28 June 2019.

SAMA will be submitting, and welcomes any comments and thoughts from our membership on the issues and the documents themselves.

SAMA member comments can be submitted to Jolene Hattingh in the Knowledge Management and Research Department - joleneh@samedical.org , by 15 May 2019, to enable approval of drafts and final submissions by the CMS deadline.

The Low Cost Benefit Framework has a long history, and SAMA comments on the original draft guidelines published in 2015. At that stage SAMA was positive about plans to make coverage available to more people, but concerned that the purpose of the LCBOs was not clarified and that the exemption framework accompanying the plans might undermine principles of social solidarity, community rating and open enrolment enshrined in the Medical Schemes Act. SAMA also expressed disquiet at the proposed LCBO package, which provided very low levels of healthcare protection, and was not well-aligned with National Health Policy, nor with Sustainable Development Goals.

The new discussion document seeks to re-ignite discussions on the LCBO plans, looking at international experiences, and the likelihood of uptake of such plans in South Africa, and proposes a minimum benefit framework which may be employed by schemes.

The Small Schemes Consolidation analysis looks at the characteristics and performance of small (<6 000 members) schemes, with a view to identifying characteristics which make medical schemes candidates for amalgamation, as the CMS pursues its medical schemes consolidation framework. The document finds that even small schemes may perform quite well within the set of parameters examined, suggesting that each scheme needs to be evaluated individually.

Kind Regards
The SAMA Knowledge Management and Research Team
 

The South African Medical Association - Postal Address-The South African Medical Association P O Box 74789,Lynnwood Ridge Pretoria 0040, South Africa Physical address The South African Medical Association, Block F Castle Walk Corporate Park Nossob Street Erasmuskloof Ext3 Pretoria 0181,
South Africa www.samedical.org

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