Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Announcements of changes to benefits and contributions for 2024 by some medical schemes in media

12 October 2023 Council for Medical Schemes

The Council for Medical Schemes wishes to clear the air of speculation around changes to benefits and contributions made by some medical schemes in media.

For the benefit of the public, the CMS regulates seventy-one (71) medical schemes and sixty-six (66) of the schemes complied with the Circular 27 of 2023 directive. To our knowledge, only five (5) schemes made public pronouncements on changes to benefits and contributions for 2024, without indicating the planned changes are subject to approval by the regulator.

CMS is pleased with the sixty six (66) medical schemes that complied with the guidance provided in Circular 27 of 2023 and relevant provisions of the Medical Schemes Act (No 131 of 1998).

The CMS Regulation Division is engaging with the identified affected schemes for finality on the matter.

Shock Move
In a shock move, some medical schemes seem to suggest, according to a Business Live report, that Section 31 (2) of the Medical Schemes Act 131 of 1998 should not apply and that ‘no law has been broken.

Section 31 (2) is definitively clear – ‘no rule amendment, recission or addition is valid unless it has been approved by the Registrar.’ Based on this rule of law, the circular further emphasised “The Registrar will communicate the decisions (approvals / rejections) in November 2023. Only contribution increases that have been approved by the Registrar may be implemented by medical schemes.”

Further to this, Section 57 (4) (d) of MSA binds the Board of Trustees of Medical Schemes to ‘ensure that adequate and appropriate information is communicated to the members regarding their rights, benefits, contributions in terms of the rules of the medical schemes.’

CMS acknowledges that medical schemes may want to communicate the planned or proposed changes to benefits ahead of the approval by the regulator. However, it is important for medical schemes to clearly communicate that the proposed changes are subject to approval by the regulator.

Against this backdrop, the action imposed by CMS also seeks to protect medical schemes from investing into benefits or benefits options that are not approved or yet to be approved by the regulator.

Stakeholders in the medical schemes industry
There are procedures set out in MSA if medical schemes or anybody is aggrieved or not happy with the regulator’s decision.

Only the CMS is tasked with the mandate of regulating the functioning of the medical schemes and we urge stakeholders to be cautious in making statements that are contrary to the provisions of MSA.

Medical Scheme Members
Altogether, the CMS urges medical schemes members not to panic. Medical schemes have submitted benefit and contribution change proposals for 2024 and are being evaluated independently without fear or favour.

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