Creating urgent medical aid cover for a group of members from a liquidated open medical scheme

Business Imperative:
The Council for Medical Schemes (the Regulator) was granted the authority by the Master of the High Court, to put an open medical scheme in liquidation, due to the curatorship process having unfortunately failed to bring about the anticipated turnaround for that scheme.

Another medical scheme was approached to create an immediate “home” for the affected members who would otherwise have been left without medical aid cover. The members were to be taken on without any general or condition-specific waiting periods.


Complication:
In the absence of a proper due diligence and only minimum risk mitigation structures  being allowed, the existing members of the other medical scheme would have been adversely affected by the take-on.

This medical scheme had just taken over a 30,000-member scheme from 01 October 2010, and these members still needed  settling-in. The Scheme was therefore running the risk of fatigued employees who could have become de-motivated.


Solution:
Mandated by the Board of Trustees and the Regulator, a project  for the take-on process was established. The Project Team comprised selected Board members, the Executive Team and Staff. Other than the guidance of the Scheme’s Actuary, no other unbudgeted consulting services were contracted. A partnership with Healthcare Brokers responsible for the members of both schemes was formed and educational workshops conducted. Thorough communication to both the current and incoming members was extensively conducted.
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Impact/Outcome:
The Scheme’s unplanned expenses were kept to a minimum.

The inclusion of and frank communication with all Stakeholders affected by the process ensured minimum adverse impact to both the current and incoming members.