Members of a number of plans on the Bonitas Medical Fund had key benefits removed without being adequately informed beforehand of the changes. Members, who were able to choose their plan (or option, as it is known in the industry) for 2021 late last year, were only informed this year that procedures for which they thought they were covered had been excluded.
So says a broker who wants to remain anonymous, who contacted Personal Finance expressing her unhappiness with the way Bonitas had apparently deprived members of benefits they had signed up for, and questioned why the Council for Medical Schemes (CMS), which must approve all benefit changes, had allowed the belated exclusions.
Specifically, according to the CMS-approved annexure to the scheme's rules, all back and neck surgery, unless a prescribed minimum benefit, was excluded on BonSave, BonFit Select, Primary, Primary Select, Hospital Standard, Bon Essential, BonEssential Select, BonCap, BonStart, effective February 22. While the original annexure was signed off by the CMS on November 11, 2020, amendments to the annexure, which included the back and neck surgery exclusion, were signed off only on February 25 this year.
Responding to Personal Finance, the CMS said back surgery and joint replacements were part of the 2020 benefits and these benefits were removed for the 2021 benefit year. It said that the relevant benefits were signed off on November 11, 2020, and that while Annexure C (the exclusion list) registered in November 2020 did not highlight these as such, they were clarified in the amendments registered in February 2021. “It would therefore be incorrect to suggest that the scheme removed such benefits in February when these were, in fact, not part of the benefits registered for 2021 in November already,” the CMS said.
The broker says members and brokers were not only not told of any such reduction in benefits before members made their choices last year; they were also not informed when the change became effective in February this year. It was only in May that brokers received a notice communicating the changes. She said the options on which back and neck surgery was still covered were unaffordable to members on the affected options.
The CMS subsequently responded: “Section 29(1)(l) of the Medical Schemes Act (MSA) provides for advance notice to be given to members. The Bonitas scheme rules provide for a 30-day advance notice to be given. Usually dates for option changes will close after the registration of rules to allow for members to make informed choices. If the scheme did not provide this notice in December 2020, then they have transgressed the MSA and their own rules.”
Response from Bonitas
Lee Callakoppen, the principal officer of Bonitas Medical Fund, responded as follows: “The scheme rules state that the board may make any changes to the rules at any time, except for certain reserved matters, which requires the consent of members. In the present circumstances, had the benefits deviated by more than 25%, then the members would have had to give their consent for the rule amendment. However, the changes to the benefits did not constitute a deviation by 25% or more and, accordingly, the board was entitled to adopt the amendments and submit them to the Registrar for consideration. Our rules, as correctly stated, were amended and approved by the Registrar in February 2021.
“The amended rules were immediately placed on the Bonitas website to ensure that members and brokers would be able to access these freely. In addition, the amended rules could immediately be accessed via any of the Bonitas customer service channels … The scheme embarked upon a communication process with all brokers regarding the rule amendments as soon as the Registrar approved them and we find it strange that it is after a significant lapse of time that this query has surfaced.
“We reject the allegations that the rule changes were detrimental to members, as we opted to manage all concerns on a case-by-case basis so that we would evaluate each case on its own merit. To date all cases that were escalated were properly considered and dealt with in a manner which did not prejudice a member.”
Callakoppen also pointed out that:
- To mitigate against any potential prejudice which members may have experienced, Bonitas allowed mid-year option changes to members requesting this.
- Due to the Covid-19 pandemic, there was a substantial decrease in elective surgeries, so that the number of members impacted by the rule amendment was limited
- Bonitas waived restrictions for members on network options during high volumes of Covid-19 cases to ensure access to care for its members. This mitigated against any possible negative impact of the rule amendment.
- Members who had planned these procedures were managed through the pre-authorisation processes to ensure they were supported.
On the apparent lack of a 30-day notice period given to members, raised by the CMS, Callakoppen said: “When scheme rules are changed, then implementation should only occur 30 days after the date of change. This means members who fell within the 30-day period were not prejudiced, as their concerns were addressed on a case-by-case basis with concessions offered to either change options or extend cover.
“We gave due consideration to each issue raised and can confirm that the process was fair and the impact did not prejudice members. There were 25 cases pertaining to surgery and we managed each as exceptions in favour of the member. The low volume of these escalations indicates clearly that the changes have had a minimal impact on members.”