Medical aids needled by claim they have failed members during pandemic

Health-care funders have hit back at claims by the industry regulator that they are not acting in their members' best interests during the Covid-19 pandemic.

In a circular on Thursday, the Council for Medical Schemes (CMS) said many medical aids had not applied for exemptions to regulations that would allow them to waive contributions for members struggling to make ends meet during the lockdown.

The CMS said only 19 schemes — including some of the biggest — had applied for exemptions, but those that had not done so provided cover for just over four million people.

The exemptions allow schemes to reduce or defer contributions for three months, or allow contributions to be paid from medical savings accounts.

On Saturday, the Board of Healthcare Funders (BHF) said the CMS accusation that its members were “denying beneficiaries relief despite extreme Covid-19 conditions” was incorrect and unfair.

Board MD Dr Katlego Mothudi said the organisation had approached the CMS at the beginning of the pandemic to ask for collective exemptions from regulations for its members.

“The regulator would not allow for a collective application but requested that medical aid schemes make individual applications for exemption consideration,” he said.

Some schemes had applied, “while others looked at their scheme rules to establish areas in which they could provide support without making the applications to the CMS, given that members needed an immediate solution”.

Mothudi said schemes' decisions not to apply for exemptions did not mean they were denying members assistance.

“It means they were able to identify areas within the scheme rules to support members without going through the individual exemption application process.”

Mothudi accused the CMS of ignoring submissions by the BHF, including a request that the council set up a “negotiation chamber” so medical aids could “collectively negotiate costs for all Covid-19 related cases” as a way of cutting costs.

He said: “In April, the BHF submitted a draft framework to support this proposal. It was accepted by the CMS with a view to seek ratification of the process from the national department of health.

“However, to date the industry is yet to receive feedback on the status of the proposed framework.”

The CMS had also rejected a proposal that would have allowed medical aids to introduce low-cost cover — something that would have “provided a much-needed financial buffer for members who can no longer afford to pay premiums during this time”.

Mothudi said: “We are now in a crisis, and medical aid schemes find themselves in a space where they have to carefully navigate the regulatory environment to ensure that they continue to provide support to their beneficiaries.

“The solutions that medical schemes came up with are in fact commendable under the circumstances, and it is very encouraging to see how BHF members have stepped up in various other interventions to tackle the challenges presented by Covid-19.”

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