Circular 50 of 2020: Industry Update on Developments Relating to COVID-19 Exemptions and Guidelines
The economic impact of the COVID-19 pandemic and related national lockdown has a direct impact on the livelihood of many medical scheme members and their ability to maintain their medical cover premiums as retrenchments and business closures escalate. The CMS has published various circulars between March – May 2020 that set out options that schemes could use to provide financial relief for their members to maintain their medical cover. Nineteen medical schemes have since applied for exemptions to the CMS for financial relief to members, which is equivalent to nearly 5 million lives and nearly half of the 2019 medical scheme population.
The CMS is concerned that a significant number of schemes, which account for nearly half of the medical scheme population, have not applied for this dispensation. The Circular states that medical scheme beneficiaries have been denied of this relief despite extreme COVID-19 conditions and their schemes seem not to be acting in their best interests. As such, the CMS will continue to monitor this inaction in the interest of protecting medical scheme members.
Circular 52 of 2020: Guidance on benefit changes and contribution increases for 2021
This Circular prescribes the requirements that medical schemes must adhere to for the assessment of annual medical scheme contribution increases and benefit changes for the 2021 benefit year. The Circular outlines the key industry specific considerations that the CMS will consider when assessing the appropriateness of benefit changes, contribution rate increases, and overall cost increase assumptions for 2021. Based on the economic impact of COVID-19, one of the recommendations made by the CMS is that medical schemes that are in a strong financial position, must consider freezing contribution rate increases for the 2021 benefit year. In cases where schemes are unable to freeze their contribution increase for 2021, the CMS recommended that schemes should limit their increases to 3.9% in line with CPI. The guidance is currently in consultation phase.
Updated PMB definition guideline for COVID-19
On 20 July 2020, the Council for Medical Schemes (CMS) published PMB definition guideline: COVID-19 v4 which is an updated version of the Prescribed Minimum Benefits for COVID-19.
The major changes in this version of the PMB guideline expands on:
- Inclusion of palliative care
- Recommendation on corticosteroid use, remsedivir, chloroquine or hydroxychloroquine prophylaxis, convalescent plasma
- Funding of PPE for confirmed cases
- Emphasis on blood saturation results not gases for oxygen funding
- Amendment to radiology codes
- Inclusion of non-invasive ventilation