Pretoria - The Council for Medical Schemes has been ordered to hand over the complete record containing its decision-making process.
It is a first victory for the Board of Health Funders (BHF) in its legal quest to overturn the moratorium which prohibits medical schemes from providing low-cost benefit options to the public.
The Gauteng High Court, Pretoria, ordered the Minister of Health and the Council for Medical Schemes (CMS) to provide all of the papers asked for by the BHF within 10 days so that this body for medical schemes can take its main case forward.
In the main application, it will fight the moratorium, which, in effect, prevents members of the public who cannot afford a full medical scheme membership from obtaining low-cost benefit options.
The BHF said that the completion of this crucial milestone hinges on the provision of several documents, which they eagerly await.
“This significant victory brings us closer to the ultimate goal of granting medical schemes exemptions to offer low-cost benefit options (LCBOs), which aim to provide greater access to affordable medical scheme benefits for low-income earners,” it said.
The BHF, the applicant, said that its first step victory aligns with the mission of improving health-care accessibility and advancing progress towards universal health-care coverage in the country.
In the main application lodged in August, the board requested the court to lift the moratorium that prevents medical schemes from offering LCBOs when the Council for Medical Schemes refuses to grant applications for exemptions to medical schemes, pending the finalisation of Low-Cost Benefit Options guidelines.
The applicant is also asking the court to declare the failure by the respondents to develop and implement Low-Cost Benefit Options guidelines as irrational, unreasonable, and unlawful, as per the Promotion of Administrative Justice Act and the Constitution.
The Board of Health Funders represents the majority of the country’s medical schemes and healthcare funders, encompassing schemes and administrators serving nearly 4.5 million individuals.
According to Charlton Murove, of the Board of Health Funders, the protracted process of crafting a framework for Low-Cost Benefit Options has taken more than seven years and was yet to be finalised.
“Many policymakers have criticised medical schemes for their lack of affordability.
“The proposed solution aims to address these concerns and move closer to the principles of universal health-care coverage, ensuring that the health-care system grants everyone access to quality and affordable health care,“ Murove said.
He added that this application sought to drive a progressive agenda for the public and private health-care sectors, fostering collaboration to alleviate the current challenges in the country’s health-care system.
“The Council for Medical Schemes and the minister have pivotal roles in implementing policies that enhance access to healthcare.
“However, progress with Low-Cost Benefit Options has been hindered by the Council for Medical Schemes’ failure to take the necessary steps for reform, despite the publication of demarcation regulations in 2016.”
He said that the Board of Health Funders’ victory in obtaining the documents needed to proceed with the main application represents a significant step forward in the pursuit of affordable and accessible medical scheme benefits.
“By addressing the current burdens faced by the state and ensuring that medical scheme premiums remain affordable, we can strive towards a health-care system that benefits all South Africans,” Murove said.
Pretoria News