Who we are
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BHF is the representative organisation for the majority of medical schemes throughout South Africa, Namibia, Zimbabwe, Botswana as well as Lesotho. This is an organisation that will provide you with relevant, up-to-date information; engage with government on your behalf; and, provide services which will add value to your business.
As the industry representative body, the organisation relies on the membership of all medical schemes to ensure that it is able to engage with policy makers and other organisations effectively and to influence policy where necessary on behalf of the entire industry.
Our Vision
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To have a (Private) Healthcare Funding system that ensures lifetime access to essential and affordable healthcare for the family of the average working person in Southern Africa.
Our Mission
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We exist as an industry representative body, providing a platform on which key players in the private healthcare funding industry converge, and a vehicle to be used by this industry to pursue its interests and a crucible in which cutting edge issues are debated, discussed and packaged to policy positions. We also must play an advocacy role in the Southern African region. We must mediate and arbitrate between the members and be the glue between the BHF Chambers.
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The following over-arching activities are crucial:-
- To represent and interact with our membership on an ongoing basis, communicating appropriately with relevant stakeholders and sharing information.
- To develop, maintain and nurture a strong working relationship with Government Policy makers viz: Minister of Health, Director General of Health, Minister of Finance and Director General of Finance in South Africa, Namibia, Lesotho, Zimbabwe and Botswana. The Strategy Policy issues, legislation, and direction affecting the industry discussed at this level must include BHF, preferably at the "soft pencil" stage in order to ensure that the memberships interest are represented.
- The Council for Medical Schemes (CMS) is the regulator of the Private Healthcare Funding Industry and the BHF needs to develop, maintain and nurture a strong working relationship with its Registrar/CEO. The BHF as a representative body of the Private Healthcare Funding industry, and CMS, should operate as "two sides of the same coin" and be "joined at the hip" in order to ensure that the membership is adequately represented and engaged with. This will ensure alignment of industries' objectives and similar relationships should be fostered in Namibia, Lesotho, Zimbabwe and Botswana.
- To interact with relevant bodies like the Competition Commission, Pricing Committee, Medicines Control Council, Consumer Bodies, Labour Organisations and Trade Unions, Business Community (BUSA) and NEDLAC in order to foster good working relationship within the Southern African healthcare environment.
- To interact constructively with all the healthcare providers, on whom we depend, to render healthcare services to our members in order to build trust and ongoing relationship for the benefit of the membership.
Core function areas of BHF:
- Benefit and Risk
- Communications and Marketing
- Practice Code Numbering System (PCNS)
- Healthcare Forensic Management Unit (HFMU)
- Trustee Training
- Legal
Every individual at the BHF is important and our core values of Commitment, Leadership, Innovation, Inclusivity, Excellence, and Communication are carried through from board member level to frontline staff. The BHF brand is about representing and serving with Integrity.
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Dr Z.H. Zokufa
MD
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To visit dedicated pages for the various function areas, please click on the appropriate link below.
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Benefit and Risk
The overall focus of the Benefit and Risk department is on minimising risks to which schemes are exposed in providing benefits for their members. It ensures that benefits are designed, worded and coded in such a way that there is little or no opportunity for misuse or abuse.
Three panels support the work of the Benefit & Risk Department: the Clinical Advisory Panel (CAP), the Coding and Hospital Panel (CHEP) and the Criteria Committee.
The CAP researches and compiles funding recommendations relating to:
- Drugs and related substances
- Investigations and diagnostic tests
- Equipment and hardware
- Evidence-based clinical guidelines for old and new therapies.
Recommendations emanating from this committee would be regularly reviewed and updated and provided as guidelines to schemes to assist them in offering greater consistency in benefit design and claims adjudication, as well as to assist members to understand the limitations of less expensive options.
The CHEP focuses on specific problems with hospital codes and descriptors, the consumable (non-chargeable) list and new equipment billing practices. It also examines hospital "baskets" for theatre time, ward days, maternity and the like and the development of a zero-based costing document for these fees. While the focus of this panel is on hospitals, they also attend to the schedules of other disciplines.
The Criteria Committee examines requirements for facilities to qualify for PCNS allocation. In consultation with various professional associations, it also gives guidance to schemes about applicable tariff codes chargeable by different categories of facility.
Strategically the department is moving towards initiatives to create more value for medical schemes. The implementation of managed care will become a focus, particularly in assisting medical schemes to determine issues such as surgeons' qualifications, the relative benefits of one surgical method as opposed to another, guidelines for the use of therapies relative to side effects, cost, age of patient and the like. Recommendations and guidelines which reflect industry standards need to be established to enable medical schemes to make informed decisions for each individual case.
The strategic focus for this department for 2006 is as follows:
- To provide input into the NRHPL and to monitor the impact to schemes on:
- Oncology tariffs
- Radiology tariffs
- ICD 10 Coding
- Prescribed Min Benefits (Industry Standard Guidelines for 25 Chronic PMB's, Obstetric Care)
- Theatre/Ward Baskets
- New equipment formulas
- Orthotic and Prosthetic Tariffs
- Mid-year tariff adjustments
- Consultative vs Procedural Services
- Unbundling
- SAMA-CPT conversion: cherry picking
- Removal of Rule C
- Low flow anaesthesia
- To compile the following guidelines for schemes:
- Tariff Interpretation Guide
- ICD10
- Dispensing vs Administering medicine
- DSP Framework
- Super-speciality accreditation
- To work on a standardized set of guidelines for minimum care for 25 PMB's (consultations, investigations, ancillary) to assist schemes. Examples of this would be that the basic level of maternity care as PMB would be midwife delivery (unless referred by midwife to obstetrician), or where a provider is unwilling to sign a DSP agreement, the maximum liability of scheme should be NRPL if member has no reasonable alternative (i.e. provider cannot balance bill member).
- Super Specialty Accreditation - to limit certain procedure codes to practices with training and accreditation in these procedures.
- This has already been put in place for anaesthetics, but is still needed for the following: Neuro-intervention procedures, Cardiac catheterization, Laparoscopy and Endoscopy.
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Corporate Communications
As a knowledge based organisation, the effective dissemination of information to industry stakeholders is critical. This is done through the media, seminars and workshops, newsletters and other communication modalities to four key industry stakeholder groupings, namely; medical schemes and administrators; medical scheme members and consumers; regulatory authorities and relevant government departments; business and labour organisations.
BHF Annual Southern African Conference
The annual conference showcases the sector, drawing people not only from the medical scheme sector, but many other related organisations including government departments, actuaries, switching houses, insurance brokers and various provider associations. The conference is seen as a unique opportunity to network and hear of latest trends and developments both locally and internationally. The focus is generally on issues of a more strategic nature.
To read more on this event, please → click here
Trustee Development Programme
More than ever before, Trustees of medical schemes are entrusted with the Governance of their scheme and have the responsibility of ensuring that any decisions made regarding the operational aspects of the scheme are made prudently and within a strict legal framework. In order to equip Trustees with the requisite knowledge, BHF have developed a Trustee Development Programme which covers aspects such as:
- The legal and fiduciary responsibilities of Trustees, including fiduciary and statutory functionality, general responsibilities, fiduciary duties, high risk responsibilities, investing medical scheme funds.
- A review of market dynamics in light of the current and proposed medical scheme legislation in SA, including the implementation of Social Health Insurance, system, the Risk Equalisation Fund, PMB's, mandatory cover, solvency, tax subsidy issues, etc.
- Act 101 - The effect on medical schemes of the Single Exit Price and the new dispensing license obligations.
- Designing benefits and contracting designated service providers.
- HIV/AIDS - what Trustees should know when making funding decisions, including the management of the disease and the impact to medical schemes.
- Combating medical scheme fraud and abuse through collective action
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To read more on this programme, please → click here
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HFMU division
The HFMU has undergone some major changes and we are excited to announce the latest advancements that have been made within this BHF division and the industry as a whole.
EHFCN 2011 Annual Conference Krakow 10.2011
- "The Chairman of the HFMU signed a Memorandum of Understanding, on behalf of the HFMU, in Krakow, Poland on 6/10/2011 with EHFCN, the CHCAA, the NHCAA & the HICFG." - Lynette Swanepoel
**EHFCN = European Healthcare Fraud & Corruption Network; CHCAA = Canadian Healthcare Anti-fraud Association; NHCAA = National Healthcare Anti-fraud Association; HICFG = Health Insurance Counter Fraud Group
Signing of MoU in Krakow, Poland - 6/10/2011
For more details and to download the available presentations please click here.
Click here to join our Group. Members only.
PCNS division
The Practice Code Numbering System (PCNS) of BHF is a list of unique practice billing codes for providers of healthcare services in South Africa, Namibia and Lesotho.
The practice number, allocated to all registered healthcare providers is a legal requirement for the process of reimbursement of a claim to either a medical scheme member or service provider. This is in accordance with the requirement of the Medical Schemes Act 131 of 1998 wherein it is stated that a medical scheme may only reimburse a member or a provider of relevant healthcare services for services rendered against a valid practice code number.
What would you like to do?
- Apply for a practice number.
- View Legislation Requirements regarding a practice number
- Check PCNS Annual Renewal fees for 2011
- View my PCNS statement
- Check PCNS Payment Options. (BHF banking details)
- Make an On-line Payment
- Update my practice details
- Search for a service provider
- Dispensing License Search