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Health minister Zweli Mkhize has thrown the medical schemes industry a lifeline, with provisions in the latest iteration of the National Health Insurance (NHI) Bill that enable them to continue until the ambitious scheme for universal health coverage is fully implemented.

At that stage, they will be restricted to offering cover for “complementary” services not covered by NHI.


The development will offer welcome reassurance to medical schemes, their administrators and brokers, which feared they might be legislated out of existence in one fell swoop. The transition is also likely to give comfort to consumers who currently use medical schemes to pre-fund their access to private healthcare services.

The bill, which was introduced to parliament on Thursday, paves the way for the establishment of an NHI Fund, which will purchase services on behalf of patients from accredited public and private healthcare providers.

Clause 33 of the 60-page bill says: “Once NHI has been fully implemented as determined by the minister through regulations in the [Government] Gazette, medical schemes may only offer complimentary cover to services not reimbursable by the fund”.

The bill says NHI is to be phased in and is to be fully implemented by 2026.

“Medical aids will have no trouble adapting to the changing environment, by developing products and services that provide complimentary cover,” said Mkhize during a media briefing in Pretoria.

The medical schemes industry provided cover to 8.87-million people at the end of 2017, according to the Council for Medical Schemes’ most recent annual report. At that stage, this represented about 15.6% of the population.

SA’s biggest medical scheme administrator Discovery Health said it is studying the implications of the bill for the future role of medical schemes, as these are not entirely clear.

“We firmly believe that once South Africans have contributed to the NHI, they should have the freedom to purchase cover through medical schemes for any healthcare services, including those provide by the NHI, should they wish to do so,” said Discovery CEO Jonathan Broomberg.

In addition to worrying about the future role of their client schemes and the implications this has for their business prospects, medical schemes are also anxious about their prospects for contracting with the NHI Fund.

Aquina Thulare, who works in President Cyril Ramaphosa’s NHI “war room”, dashed these hopes, saying the bill made it clear that the NHI Fund was to be publicly administered. “That function is not going to be out-sourced.”

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