Council for Medical Schemes urges schemes to consider 3-month premium holiday

Image credit: Twitter/@CMSCares4u

The SA Council for Medical Schemes (CMS) has encouraged medical schemes to consider giving their members a three-month payment holiday in light of the coronavirus (COVID-19) pandemic’s economic impact.

In a press release on Thursday, the medical schemes regulator also encouraged schemes to cover the screening, diagnosis, treatment and care for coronavirus.

CMS said medical schemes have so far not been obliged to pay for COVID-19 tests where members receive negative results. Most schemes have only paid for the tests and treatment when members test positive.

Loss of income

To address this, CMS Chief Executive and Registrar Dr Sipho Kabane said, “The CMS lodged a draft amendment to the Prescribed Minimum Benefit (PMB) regulations with the Minister of Health to cover the screening, diagnosis, treatment and care of COVID-19 as part of the PMB package.”

Kabane urged schemes to assist members who have lost income as a result of the pandemic and the subsequent extended lockdown.

“Schemes should investigate all disruptions to member contributions on
a case by case basis and determine the merits thereof, before suspension or termination of membership,” he said.

The CMS said small, medium and micro-sized enterprises (SMMEs) affected by the pandemic should make a case to their respective medical schemes for financial relief to protect their employees’ membership cover.

Industry-wide engagement

Kabane said, “To ensure that medical scheme members have continued access to healthcare services and to prevent the possible exploitation of patients as a result of the COVID-19 pandemic, the CMS is facilitating an industry-wide engagement to develop a price and tariff negotiations framework.”

As of Thursday, 16 April, South Africa had 2,605 confirmed cases of COVID-19 after more than 95,000 tests countrywide.

48 people had lost their lives. On the more positive side, Health Minister Dr Zweli Mkhize said 903 people had recovered from the disease.

Last week, President Cyril Ramaphosa extended the nationwide lockdown by two weeks until the end of April.

On Thursday, Minister of Cooperative Governance and Traditional Affairs, Dr Nkosazana Dlamini-Zuma, said the lockdown will be lifted “incrementally.”

“Because we are going to be opening the lockdown in an orderly matter, we will be naming the areas which will opened from the lockdown. The lockdown cannot be stopped abruptly,” she said.

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