Medical scheme bodies lose PMB case

In case the news hasn’t reached you yet, the BHF and SAMWUMed have lost the PMB (prescribed minimum benefits) court case.

The prescribed minimum benefits and the law which prescribes them remain in place.

The North Gauteng High Court handed down the ruling yesterday after the Board of Healthcare Funders of Southern Africa (BHF) - later joined by the South African Municipal Workers’ Union National Medical Scheme (SAMWUMed) - challenged Regulation 8 of the Medical Schemes Act 131 of 1998. The two bodies were seeking to have Regulation 8 interpreted to mean that schemes must pay for PMB conditions only up to the scheme tariff, effectively changing the meaning and purpose of the PMB provisions in the Act.

While supporting the ruling and having spent considerable time and effort in backing the CMS in its year-long defence of Regulation 8, SAMA believes that the Competition Commission ruling banning medical schemes and provider groups from negotiating tariffs should be revisited.

Although it is a victory for the CMS, for those who backed the CMS cause, and particularly for medical scheme members, it is nonetheless SAMA’s contention that this is another one of those issues that should never have ended up in court. It was not a misunderstanding of the PMB rules, but, according to SAMA, a development that can be directly attributed to absolutely no mechanism being available for providers and schemes to negotiate on tariffs and possible issues surrounding them.

SAMA now hopes that the medical schemes will now join the association and its members in pushing for a new era when provider groups and funders can engage positively on pricing requirements.

*Yesterday’s judgement can be found on the CMS website (www.medicalschemes.com) or at this link:

http://www.medicalschemes.com/files/Judgements%20on%20Appeals/BHFvsCMS_Reg8PMB.pdf.

Click on this link to view related ITI News article: Prescribed Minimum Benefits (69.99 kB)