Pronouncements on Low Cost Benefit Options

The Council for Medical Services (CMS) plays a critical role in providing strategic advice and support for the development and implementation of national health policy. Included in the ambit of this role is supporting the development of the National Health Insurance (NHI) framework and its implementation process.

In its effort to align medical aid scheme offerings to the proposed NHI Bill, the CMS has now begun to implement certain changes. In Circular 80 of 2019 dated 4 December 2019, the CMS announced that it would be abandoning a decade-long project to make private healthcare available to about 8 million lower-income households.

The premise of a Low-Cost Benefit Option (LBCO) intended to increase the affordability of membership to medical aid schemes through the development of a product targeted to a specific group of the population. The CMS claims that these options, however, have lent themselves to the delivery of inferior benefits and published the details of their findings in the Circular.  The options also do not provide cover for PMB’s.  The CMS has been working with a PMB committee to develop a PMB package with a specific focus on primary healthcare (PHC). Whilst yet to be costed, the proposed PHC package aims to:

  • address the CMS’ concerns with LCBO’s;
  • create direct and efficient access to quality healthcare; and
  • offer excellent healthcare financing packages to South African citizens.

The CMS has called upon all the relevant stakeholders to support the healthcare industry as it moves towards providing quality healthcare that is “…affordable, accessible, equitable and for all.”  We anticipate a consultative process that will include government, the CMS, medical aid schemes, as well as private and public healthcare stakeholders. This engagement is imperative to the process of providing a framework that ultimately addresses healthcare needs whilst recognising fiscal constraints.

We look forward to the guidance that the CMS will provide as it relates to changes in medical aid scheme cover, as well as clarity on the vaguer details of the proposed bill. More importantly, however, we look forward to continuing to provide quality healthcare to all our members.