The Supreme Court of Appeal has opened the way for the Board of Healthcare Funders (BHF) to continue its legal fight for medical schemes to be able to offer low-cost benefit options.
Last week the SCA agreed to hear oral arguments from the BHF in its application to appeal against a high court ruling that dismissed its application to compel the Council for Medical Schemes (CMS) to open the market to LCBOs.
It has also asked the BHF to be ready to argue the merits of its case, should it agree to hear its appeal.
LCBOs are cheap, pared-down options that are tailored to the needs of low-income workers and provide fewer benefits than the statutory minimum.
The Medical Schemes Act says all medical scheme options must at the very least provide cover for a basket of care known as the Prescribed Minimum Benefits.
The BHF is an industry association for medical schemes and administrators and estimates LCBOs could enable about 10-million people on low incomes to pre-fund primary healthcare in the private sector instead of paying for these services out of pocket.
Health minister Aaron Motsoaledi has questioned the merits of LCBOs, arguing that they cover benefits that are already offered free of charge at state clinics.
In April the high court in Pretoria dismissed the BHF’s application to compel the CMS to open the way for LCBOs on procedural grounds and on the merit of its case.
The BHF had asked the court to declare the CMS’s failure to develop a regulatory framework for LCBOs as irrational and unlawful and direct it to grant general exemptions or consider individual exemption applications for medical schemes to offer these products.
It had also asked the court to declare certain decisions by the CMS and its registrar to be irrational and unlawful, including its decision to grant exemptions to the Medical Schemes Act to a limited number of health insurers that offer LCBO-like products.
The BHF’s application to the high court for leave to appeal was unsuccessful, and then it petitioned the SCA directly.
The latest development was welcomed by the BHF, which said: “This court challenge is of significant public interest, and we are encouraged that the country’s appellate court has granted us the opportunity to place before it the appeal and potentially the vital constitutional and healthcare access issues raised in the matter.”
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.