Council for Medical Aid Schemes – Undesired Business Practice Submissions

The Council for Medical Aids Schemes has stated in their latest circular that submissions to the recent Undesired Business Practice. A proforma document has been circulated that is not aligned with the method of submission required.

This proforma document has been circulated through pharmacies and brokers to the public. The CMS states that this is not the correct procedure for applications. This is taken seriously by the council as it undermines what the Medical Aid Schemes Act seeks to achieve. The incorrect procedure will invalidate submissions and thus counter the aims of the Undesired Business Practices document. This was noted and publicised in Government Gazette 435 of 2017

The persons wishing to submit applications only need indicate whether co-payments are levied when they use service providers for medication not listed by the medical aid scheme, sign their name and provide personal details.

There are provisions for members of the council to reduce their costs when funding the Prescribed Minimum Benefits (PMBs). Furthermore, there are allowances for instances where the listed service providers are too far from the person’s place of work or home.