Microsoft word - may2011_draft v2.docx

MediKredit Integrated Healthcare Solutions (Pty) Ltd
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Please find below a summary of the May 2011 industry news, happenings and regulatory matters for your attention. If you have any queries on the matters below, you are most welcome to contact your Business Operations Specialist, Relationship Manager or myself for further discussion or if you require copies of any of the publications, gazettes or CMS publications mentioned below.
1. The Council for Medical Schemes
• CMS Circular 17 of 2011: Comment invited on definition of BDs

In the CMS Circular 17 of 2011 published on 13 May 2011, the CMS have invited affected
stakeholders to submit written comment, including the cost impact of the Benefit Definitions (BDs) in accordance with the data col ection sheet, by 10 June 2011.
The CMS commenced a process during 2010 to better define PMB benefits through the development of explicit BDs for PMB conditions prescribed in the PMB regulations. As part of the process the CMS has received stakeholder submissions, established advisory committees to consider the submissions and have developed draft BDs.
• CMS Press Release 19 of 2011: Former members of Protea Medical Scheme are protected
In light of the fact that Protea Medical Scheme has recently been placed under provisional liquidation, the legal unit of the CMS have published a press release dated 25 May 2011 as a reminder that the
Medical Schemes Act prescribes that any member who wishes to join a medical scheme must be al owed to do so and be admitted to the open medical scheme of his/her choice. Al open medical schemes are therefore legal y obliged to admit former members of Protea Medical Scheme without engaging in any form of discrimination. Directors: Dr S C P Belamant; A W Brunyee; W J du Plessis ; H G Kotzé
• CMS Press Release 3 of 2011: The CMS has announced that Bonitas has been placed
under curatorship
The CMS has announced that Bonitas has been placed under curatorship and that the South Gauteng High Court has appointed Mr. Joseph Maluleke as the curator on 27 May 2011.
Based on this ruling, the scheme’s Board of Trustees and acting Principal Officer have been removed from office and replaced by the curator. The CMS further elaborated that the need for a curator is not in any way a reflection on the financial stability of the scheme or on its ability to honour claims. Bonitas remains one of the biggest and healthiest medical schemes in South Africa. At the end of 2009 Bonitas had more than 650 000
• CMS Circular 18 of 2011: Schemes notification of dates for the holding of scheme
meetings and elections

In the CMS Circular 18 of 2011 published on 23 May 2011, the CMS are requesting the medical
schemes to notify them of the dates for the holding of scheme meetings and elections. This circular is a cal upon al medical schemes to notify CMS in writing: Of a date on which a medical scheme intends to hold an AGM or special general meeting; Of a date on which a medical scheme intends to hold trustee elections. This circular is effective immediately upon release. • CMS Circular 20 of 2011: Pro-ration of benefits upon resignation / termination of
membership

CMS Circular 20 of 2011 was published on 30 May 2011 in respect of pro-ration of benefits upon
resignation / termination of membership. Regulation 9 of the Medical Schemes Act states as fol ows:
“9. Limits on benefits
A medical scheme may, in respect of the financial year in which a member joins the scheme, reduce the annual benefits with the exception of the prescribed minimum benefits, pro-rata to the period of membership in the financial year concerned calculated from the date of admission to the end of the financial year concerned.” The correct application of Regulation 9 applies when a member is admitted during the course of a financial year and the benefits are adjusted in proportion to the period of membership, calculated from the date of admission to the end of the particular financial year. However, Regulation 9 has been interpreted to imply that benefits may be applied retrospectively if the member resigns or terminates membership during the same year of joining the scheme. There is no basis for this interpretation and Medical Schemes and administrators are requested to refrain from such an interpretation with immediate effect. 2. Legislature
• COIDA Annual Increase in Medical Tariffs for Medical Service Providers, Pharmacies and
Hospital Groups

In the government gazette dated 24 May 2011, it sets out the amended Annual Increase in Medical
Tariffs for Medical Service Providers, Pharmacies and Hospital Groups in terms of COIDA for the
The fees appearing in these Schedules are applicable in respect of services rendered on or after 1
April 2011 and excludes VAT.

• Health Budget Vote Policy speech by Minister of Health: Dr A Motsoaledi
The Health Budget Vote Policy speech was delivered by the Minister of Health: Dr A Motsoaledi to the National Assembly on 31 May 2011.
In this speech the Minister highlighted the fol owing issues: The budget of the Health Sector 2011/12 to 2013/14 financial years In his speech the health Minister announced that the Department of Health is currently working hard in preparing the ground for the implementation of the National Health Insurance (NHI). The minister stated that “for us the NHI involves more than the release of the document. It involves an extensive preparation of the health system while at the same time preparing a policy document". The NHI cannot be sustained by the current health care system which means that both the public and the private wil be completely re-engineered. The present health care system is characterized by 4 very clearly defined negatives: It is very hospicentric or curative in nature. The abovementioned re-engineering of the Health Care System wil be accordingly 3 main A district based model. A team of 5 specialist or clinicians shal be deployed in each district who wil focus on maternal and child mortality. School Health Programme. This wil be launched with the Ministers of Basic Education A ward based PHC model. 10 wel trained PHC workers wil be deployed per ward. The budget of the Health Sector 2011/12 to 2013/14 financial years:
The health department's budget has increased from 21,7 bil ion in the 2010/11 financial year to 25,7 bil ion in the 2011/12 financial year. This is an increase of 15,3%. The Minister also announced additional funding of R692 mil ion for the financial year 2012/13; R2, 276 bil ion in the financial year 2013/4 for the improvement of the quality of health, strengthening of primary healthcare teams and the improvement of maternal and child health in
3. General

• Stats SA General Household Survey 2010
The General Household Survey (GHS) 2010 was conducted by Statistics South Africa (Stats SA) in Household access to services and facilities
Summary of key findings pertaining to health:
Public clinics (60,8%) were the most frequently used health facilities among sampled individuals, fol owed by a private doctor (24,3%) and a public hospital (9,4%). The vast majority of households (91,1%) used the nearest facility of its kind. Those who did not use the nearest health facility general y travel ed elsewhere and did so mainly because they felt that the waiting period was too long at their nearest facility (10,3%). Nearly a quarter (24,3%) of South African households had at least one member who belonged to A relatively smal proportion (17,6%) of the individuals in South Africa had medical aid coverage in 2010. The Western Cape (24,4%) and Gauteng (26,5%) had the highest percentage of medical aid membership while Limpopo (8,6%), Eastern Cape (12,1%) and Northern Cape (13,6%) had the lowest proportion of medical aid members. White people were much more likely to belong to a medical aid scheme than individuals from other population groups. • MCC withdraws license for Avandia
The Medicines Control Council (MCC) has issued a notice to withdraw registration for Avandia, a diabetes drug manufactured by GlaxoSmithKline (GSK). The decision fol ows that of their counterparts in Europe over safety concerns. The US Food and Drug Administration (FDA) is also concerned about Avandia's safety, and although they have yet to withdraw Avandia, they has restricted its use to specific patients. Avandia (active ingredient rosiglitazone), was designed for treating type 2 diabetes. Due to the drug’s relative high cost it has not been available to state patients in South Africa and has only been used to
Matthew Dijkstra
MediKredit Integrated Healthcare Solutions (Pty) Limited Direct Number: +27 11 770 6411
Cell Number: +27 72 230 4490
Email: [email protected]

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