KEY INDUSTRY ISSUES
National Health Insurance (NHI) is a health financing system that is designed to pool funds to provide access to quality, affordable personal health services for all South Africans based on their health needs, irrespective of their socioeconomic status. NHI is intended to ensure that the use of health services does not result in financial hardships for individuals and their families.
Legislation & Policy Documents
Prescribed Minimum Benefits
PMBs were introduced into the Medical Schemes Act to ensure that members of medical schemes would not run out of benefits for certain conditions and find themselves forced to go to state hospitals for treatment. These PMBs cover a wide range of close to 300 conditions, such as meningitis, various cancers, menopausal management, cardiac treatment and many others including medical emergencies.
The Demarcation Regulations seek to clearly demarcate the responsibility for supervision of medical schemes and health insurance products, and ensure that health insurance products do not undermine the medical scheme environment, resulting in better protection of consumers.
Three categories of health insurance products are of particular relevance to the abovementioned demarcation, namely:
- Medical Expense Shortfall policies (Gap cover plans): These policies cover the shortfall between medical scheme benefits and the rates that private medical service providers may charge.
- Non-medical expense cover as a result of hospitalisation policies (Hospital cash plans): These policies pay out a stated benefit upon hospitalisation, usually per day spent in hospital. The stated benefit is unrelated to the actual cost of any medical service as it is aimed at covering incidental costs, such as loss of income.
- Primary healthcare insurance policies: These policies provide limited medical service benefits (often to employee groups or bargaining councils) including services such as general practitioner visits, acute and chronic medication, emergency medical care, dentistry and optometry.
The Immigration Act 13 of 2002 and the Immigration Regulations of 2014 require foreign students to submit proof of medical cover with a locally registered medical scheme in order to qualify for a study visa. BHF has been requested to consider, from a legal perspective, whether there is any basis in law in terms of which this requirement may be departed from, alternatively in terms of which such requirement ought to be dispensed with as a matter of law.