BHF responds to CMS media release on maternity cover
6 DECEMBER 2023 – In a media advisory issued on 24 November, the Council for Medical Schemes (CMS) accused the Board of Healthcare Funders (BHF) of presenting ‘misleading information on pregnancy’ at a recent Clinix webinar on national health insurance (NHI).
According to the CMS communiqué, in an article published in Medical Brief South Africa the BHF stated that under the amendments to the Medical Schemes Act, maternity benefits will be excluded, with pregnant mothers paying for maternity benefits out of pocket. According to the article, the BHF’s Dr Rajesh Patel was quoted as saying: “The act amendment actually states that medical schemes will not offer services and benefits for pregnancy and termination of pregnancy. Now, if the president signs it off with immediate effect, there are no more benefits for pregnancy.”
The CMS refutes this assertion as being entirely without any basis. “Maternity benefits, especially concerning pregnancy, hold significant national policy importance, as outlined in the national strategic plan and global Sustainable Development Goals (SDGs). In the context of medical schemes, maternity is categorised as a prescribed minimum benefit (PMB), mandating medical schemes to provide essential coverage. This obligation aims to ensure adequate financial and health protection for members of medical schemes.” The CMS release goes on to say that it is primarily concerned with the disinformation and misinformation peddled in the public domain by industry representatives, specifically those representing medical schemes. “Industry bodies play a pivotal role in the health sector, and it is incumbent upon them to present key policy issues clearly in the public domain without ambiguity.”
In a legal response to the advisory, the BHF counters that it has raised the issue of maternity benefits many times in its written submissions on the NHI Bill as part of Parliamentary processes. “The National Health Insurance Bill has a Schedule at the back that amends various pieces of legislation. One of them is the Medical Schemes Act. These amendments include an amendment to the definition of a ‘relevant health service’, deleting the current paragraph in the definition that includes ‘the giving of advice in relation to, or treatment of, any condition arising out of a pregnancy’.
“Under the National Health Act (NHA), being a beneficiary of a medical scheme automatically disqualifies a woman from having access to free health care services in relation to a pregnancy. NHI implementation is a process not an event. Timing is everything. If this section in the NHA is still in play when the President proclaims the Schedule in the NHI Act operational, a female beneficiary of a medical scheme will have to pay for health care services in relation to her pregnancy even if she receives them from the public sector.”
Underscoring this, Charlton Murove, the BHF’s Head of Research, states: “It is a source of concern to the BHF that its written submissions appear either not to have been read or simply ignored. The BHF feels strongly that the current wording of this proposed legislation puts women in the scheme environment seeking maternal health services at risk.
“Discussions around legislative changes are supposed to be consultative, with all role-players given the opportunity both to clarify and receive clarity with regard to the wording of draft legislation. And yet when the BHF has raised its concerns about what it considers to be a ‘drafting mistake’ with potentially serious negative unintended consequences, we just get told that we’re wrong. So we feel that there is a big ‘process issue’ here.
“Furthermore, the addition of the section that is the source of our concern is actually unnecessary. Section 33 of the bill already covers this matter and the bill would achieve its objectives without the proposed addition. Legislation should say something once and say it clearly without superfluous repetition.
“The CMS is mandated to protect medical scheme beneficiaries and it should be equally concerned about this issue, which is not a new one for us. To date its silence about the problematic wording of this amendment is cause for alarm,” he concludes.
ABOUT BHF
The Board of Healthcare Funders (BHF) is the largest industry association for health funders across 8 countries in the region, with the key aim of enabling its members to provide access to affordable healthcare to health citizens.
Spokesperson: Zola Mtshiya ; 0658192225 or zolam@bhfglobal.com
Media Liaison: Mangalisile Mzolo – email : mangalisilem@bhfglobal.com
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