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Big medical aid changes coming to South Africa – here’s what you need to know

The Council for Medical Schemes (CMS) has been tasked by the Department of Health to establish a central cache containing all medical scheme patients in South Africa.

he CMS said that this registry – called the National Beneficiary Registry – will benefit the CMS and the medical schemes industry in the following ways:

Membership history will be preserved as one Beneficiary ID number will be allocated to a member for life. This Beneficiary ID number is computed using a variable amount of data about the member, thereby creating a unique identifier for each beneficiary;

- Verification of membership status of patients that have medical aid cover, visiting state facilities;

- Demographic reporting which will aid in health planning;Improved and direct communication with members;

- Data verification and quality improvement by schemes and administrators;Monitoring of membership behaviour over time;

- Future linkage to the NHI Health Patient Registration System (HPRS).

The circular does not indicate when the new registry will be officially introduced, however, it has called on medical schemes to take part in a pilot programme later this year.

The National Health Insurance 

While the circular indicates that the registry will be tied into the NHI Health Patient Registration System at a later date, the government said that it has already begun enrolling South Africans for the incoming National Health Insurance.

Presenting his departmental budget on Friday (12 July), minister of Health Dr Zweli Mkhize said that his department has already enrolled more than 42 million South Africans in the Health Patient Registration System.

Mkhize said that this system was developed for the implementation of the NHI and will act as a ‘backbone of an electronic health patient record’.

“We have already registered 42.6 million users on the system and all South Africans will be registered by the end of this financial year,” he said.

“We support the Department of Home Affairs in the registration of babies in our hospitals, as they will then be registered automatically on the NHI patient register.

“NHI will require a digital health platform that will support the operations of the NHI Fund and work has already commenced in this regard.”

While the updated NHI bill has not been made available for public comment, the Department of Health has previously indicated that everyone that can afford to do so will be liable to contribute towards the NHI Fund.

These contributions to the NHI Fund would be in addition to any medical aid scheme premiums if individuals should choose to remain members of a private scheme.

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