ESWATINI MED UNREGULATED, CONTINUES POSING RISK TO MEMBERS

MBABANE - The country’s medical aid scheme, Eswatini Medical Aid Fund (Eswatini Med), continues to be a risk to its thousands of members in the country.

This is despite concerns raised over the years, the entity is still not regulated.

The Kingdom of Eswatini does not have a medical aid legislation and this ultimately means that all medical aid schemes must be regulated by the Financial Services Regulatory Authority (FSRA) as they collect premiums from members.

Some of the registered and licensed medical aid funds operating locally include emaSwati Care, Mphilwenhle, Lidwala Medical Aid, Oracle Health Medscheme Eswatini and SNAT Med.

With the exception of Eswatini Med, they all recognise the authority of the FSRA in the interests of members’ premiums.

Since 2019, Eswatini Med has allegedly not recognised the authority of the FSRA.

This raises the question if, in the absence of a medical aid legislation, Eswatini Med are a law unto themselves.

Slammed

Worth noting is that in September last year, Members of Parliament (MPs) slammed what they termed unfair and irregular practices by the country’s dominant medical scheme, Eswatini Med.

The MPs asked to know why the scheme was allowed to continue operating when it had financial challenges.  This happened during a sitting at the House of Assembly, after Mbabane East MP Welcome Dlamini posed an oral question to Minister for Finance, Neal Rijkenberg, regarding the status of the medical scheme. The MP asked the minister to inform the House if Eswatini Med is still fit and proper to continue operating since it is no longer able to meet its major obligations in the medical sector.

Also, the MP asked to know why the FSRA is acting in a derelict manner on its duty when it comes to the medical schemes sector.

In response, Minister Rijkenberg admitted to the House that his ministry has received a number of complaints from healthcare institutions and members on the administration of Eswatini Med.

Rijkenberg said the complaints included that the beneficiaries are not receiving the full benefits of their selected benefit options from the medical aid scheme, yet the contributions are being paid monthly.

Another complaint received, according to Rijkenberg, was that hospitalisation is limited to a few days, which is not in the agreed benefit option between the beneficiary and Eswatini Med.

He said complainants claimed that beneficiaries are required to pay in cash for over the counter medication for outpatients in the pharmacies.

“These are accusations, whether true or not, they come to the ministry, hence there is smoke and a need to deal with,” the minister said. He then informed the House that medical aid schemes do not have primary legislation to regulate and supervise their activities.

This, the minister said, poses a huge threat to the industry as there is no protection of member premiums or legislated minimum reserve requirements to protect members’ benefits.

“Therefore, by standard, the FSRA is supposed to be a legislative body that medical schemes report to. They are not required by any law to submit financial information to a regulatory body,” explained the minister. He said in an attempt to enforce compliance, the FSRA through a legal notice tried to look into the administration of Eswatini Med, however, the legal notice has limitations that do not allow the regulator to fully regulate and penetrate into the sector.

Therefore, the minister said, the ministry has engaged with FSRA to develop a medical aid Bill that supervises medical schemes and protect members’ premiums.

The Bill, according to Rijkenberg, will further set the minimum reverse requirements to protect members’ benefits and require medical aid schemes to submit financial information to the regulator.

He said although this is at preliminary stage and government understands the urgency, they will be updating Parliament on progress in the development of a regulatory framework for medical aid schemes, with the view to mitigate the gaps raised through this motion.

“We have started the engagements, FSRA is already meeting key stakeholders including the ministries and Eswatini Med. There is also a question raised around the licensing, there is a problem there too and the Bill will also address that,” said Rijkenberg.

He also clarified that Eswatini Med has not run out of money but that it was still healthy.

Admitted

However, he admitted that it was being accused of being tight-fitted, which he said was the right word to use.

“Money would flow easier before and now they are accused of not having that easy flow. “That is accusations. We will work hard on getting the Bill, it won’t be quicker, but we will bring to Parliament and fix these irregularities,” he said. MPs were then given a chance to pose follow-up questions and they raised issues that were almost similar to the complaints the minister said have been received.

Mtsambama MP Sibongile Mamba first submitted that the operations of Eswatini Med are unclear in that members subscribe every month, but seek assistance once and are informed that their money has been exhausted.
“It is not clear what happens to the money we contribute and how much I can use per month,” she submitted.

MP Dlamini’s follow-up question sought clarity on what the minister meant by saying that there is no protection for the members’ premiums.

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