The court orders the Board of Medical Plans to search source documents on low-cost benefit options

The court orders the Board of Medical Plans to search source documents on low-cost benefit options

The Board of Health Funders (BHF), which represents a large portion of the nation’s medical schemes and health care funders–serving nearly 4.5 million individuals–filed the Supreme Court in August last year asking that medical plans be allowed to offer low-cost benefit options.

On July 10, Judge Botha ruled in favor of the BHF and ordered the defendants—CMS, Registrar of Medical Programs, Sipho Kabane, and Minister of Health Joe Phaahla—to pay the costs of the application.

Botha noted in his judgment that the defendants frequently requested bonds, starting in April 2022.

“The most recent was a leniency to provide an affidavit to respond in this application,” he says, adding that any attempt to thwart court proceedings would be met with resentment.

In response to the defendant’s attorney calling the list of required documents an “appalling shopping list,” Botha said that the fact that the required documents are huge and the list is so extensive is nothing to worry about.

In its application, the BHF noted that CMS only provided information already publicly available on its website. However, the source documents on which the decision-making process was based and which reflect the deliberations were not provided.

In the main application filed on August 8, the BHF asked the Supreme Court:

  • Lifting the moratorium preventing medical schemes from providing LCBOs… pending completion of LCBO guidelines.
  • The statement that the failure to develop and implement the LCBO Guidelines is illogical, unreasonable, and illegal.

Charlton Muroff, head of research at the BHF, points out that the lengthy process of developing a framework for LCBOs has taken more than seven years and is yet to be completed.

Many policy makers have criticized the medical schemes for their lack of affordability. The proposed solution aims to address these concerns and move closer to the principles of universal healthcare, ensuring that the healthcare system gives everyone access to affordable and quality healthcare,” says BHF.

Moroff says the goal of the app is to drive a progressive agenda for the public and private healthcare sectors, and to foster collaboration to mitigate current challenges in our healthcare system.

“Progress with LCBOs has been hampered by the failure of CMS to take the necessary steps to reform, despite the publication of demarcation regulations in 2016,” he says.

Simphiwe Mofokeng, healthcare advisor at Chartered Employee Benefits, notes that the proposed implementation date for LCBOs is January 1, 2024.

“He. She It remains to be seen if LCBOs will be implemented and, if so, for how long, bearing in mind that once the NHI is fully implemented, medical schemes may only offer supplemental coverage for services not reimbursed by the fund.

“Interestingly, the current LCBO proposed benefit structure is similar to the primary care services that will be included in the NHI offering,” it notes.

LCBOs will benefit the entire healthcare ecosystem because they will provide an affordable primary health care coverage option for the healthy citizen, says Dr Rajesh Patil, BHF’s Chief Health Systems Strengthening Officer. The process should have taken six months, at least, Patel says, because the groundwork for an LCBO framework is already in place.

When contacted for comment, CMS indicated Daily Maverick To John Letsoalo, Senior Director of Legal Services. Although Letswalo read a WhatsApp requesting comment, he did not respond. Calls went unanswered first and subsequent calls went straight to voicemail. DM


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