President won’t be signing off complete NHI Bill…
The National Health Insurance Bill (B) will not be signed off by the President in its entirety once it has been approved by the National Council of...
Top up cover? Complementary cover? Confusion reigns…
Among the more debatable topics arising out of the NHI Bill, now on its way to the National Council of Provinces for pre-Presidential approval is that under national health insurance, medical schemes may only offer “complementary cover”.
Roy Watson
Jul 28, 2023
Taking the discussion further during the most recent Institute for Health Risk Managers
(IHRM) webinar, health sector legal expert Dr Debbie Pearmain reiterated that “complementary cover” in terms of the proposed legislation meant third-party payment for personal healthcare service benefits not reimbursed by the fund – “including any top up cover offered by medical schemes registered in terms of the Medical Schemes Act or any other voluntary private health insurance cover”.
“But this definition has flaws,” said Pearmain.
“What is ‘top up’ cover as opposed to ‘complementary cover’? And what are ‘personal healthcare service benefits’?”
Although the Bill refers to services not covered by the NHI Fund, it was not that simple, as
Pearmain pointed out. In the first instance, in the current context, for example, “top up” cover would mean gap cover…
AxessHealth
Discover the latest medical advancements in Africa on AxessHealth
Join the thriving community to gain access to a free, connected communications hub with unrivalled features. AxessHealth enables HCP engagement, houses educational content, provides a cross-sector communication channel, and pushes relevant news and career information to its users.
Sign up now at africa.axesshealth.org and become a thought leader shaping the future of healthcare in Africa.
“Technically if schemes are allowed to provide ‘top up’ when you have the NHI benefits, the ‘top up’ cover is adding something of value to the NHI Bill which I don’t think the
Bill envisages. The more you think about it the more confused you get,” Pearmain
lamented, noting that the “weird term” personal health care service benefits
added to the confusion.
“Restricting medical schemes to ‘complementary cover’ may constitute denial of care for medical scheme members depending on how ‘personal health care service benefits are
structured.”
Pearmain also noted that “complementary cover to services not reimbursable by the Fund
(Section 33 of the Bill)” contradicts the definition of complementary cover: “Proposed
amendments to the Medical Schemes Act (MSA) in the Bill,” she elaborated, “contradict
Section 33 of the Bill. So, if you amend the MSA, why is Section 33 necessary?
“If Section 33 is necessary, why amend the MSA?”