Cheap primary health cover deadline looms
Insurers that offer cheap primary healthcare cover are anxiously waiting to hear whether SA’s medical scheme industry regulator will grant them another reprieve from the requirements of the Medical Schemes Act, or compel them to take their products off the market when their exemption expires on March 31.
Between 800,000 and 1.5million consumers are members of primary healthcare products that provide cover for private sector medical services such as GP and dentist visits, according to industry sources.
Most of these beneficiaries are low-income workers subsidised by their employers, who cannot afford the much higher premiums charged by medical schemes.
Companies such as Discovery, Kaelo and Day1 have partnered with a closed group of insurers that were granted exemptions to the act in line with the demarcation regulations brought into effect in 2017.
The regulations aimed to help consumers by drawing a clear distinction between medical schemes and insurance products, which are overseen by different regulators and subject to different rules.
When the demarcation regulations kicked in, 11 companies selling health insurance products were granted a two-year exemption to the provision requiring them to be scrutinised by the Council for Medical
Schemes (CMS), pending the development of a low-cost benefit options framework to govern such products.
The CMS has yet to finalise this framework and has repeatedly extended the exemption period for the insurers while not permitting any new players to enter the market.
After extensive industry consultation, the CMS finalised a report on low-cost benefit options in 2023, which it has yet to make public.
Should the CMS not extend the exemption period, consumers covered by primary healthcare products would be forced to fund healthcare expenses out of pocket or rely on the public health sector, further increasing the burden on the state, said Discovery Health CEO Ron Whelan.
“It is disappointing that seven years have now passed and the opportunity to provide lowercost primary care cover through medical schemes and low-cost benefit options has not been enabled,” he said.
“Studies across the globe demonstrate that primary care access is associated with gains in economic productivity. This, along with the social imperative of ensuring better access to care and alleviating pressure on the public health sector, would be of benefit to all healthcare consumers.”
The CMS had not responded to Business Day’s request for comment at the time of publication.
Health & Science Correspondent