Medical aids challenge Namfisa directive on gym rebates

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Edgar Brandt

Windhoek-Medical aid funds in the country have challenged the Namibia Financial Institutions Supervisory Authority (Namfisa) directive to discontinue gym and wellness rebates and related activities to members, saying the decision is clinically unsound.

In a statement from Namibia Medical Care (NMC) circulated on social media, the medical aid fund said it was concerned that Namfisa did not have the authority to issue a directive to cancel the rebates, because it could have a serious impact on its members and claim patterns.

However, Namfisa, as regulatory body of the financial services sector, is adamant that it has a statutory mandate to exercise supervision over the business of financial services and financial institutions.

It said this mandate relates to amongst others the business of medical aid funds, which are governed by the Medical Aid Funds Act, 23 (Act No. 23 of 1995) and subsequent regulations, directives and notices published thereunder.

On Monday 10 April 2017, the registrar of medical aid funds issued a directive to the medical aid funds industry, informing industry players that the practice of offering gym rebates and wellness programmes as part of its benefit structures to members was in contravention of the Medical Aid Funds Act.

Medical aid funds were then directed to comply with the directive by 31 December 2018. While some have criticised the due date to comply with the directive as being too far away, the Registrar of Medical Aid Funds, Kenneth Matomola, said he deemed it best practice to provide ample time to the registered funds to amend their governing rules and rescind the rebate practice.

“Though Namfisa supports the services offered by fitness centres (commonly referred to as gyms) and deems it a necessity to members of the public in the fulfilment of a healthy lifestyle and in the prevention of certain health conditions.

“Namfisa, through the Registrar of Medical Aid Funds, is compelled by statute to rectify any malpractice which is in contravention of the applicable administered laws,” read a Namfisa statement, issued by the registrar of medical aid funds.

Matomola says that in the definition of a ‘medical service’ as specified in the Medical Aid Funds Act only a “healthcare treatment provided by a person registered in terms of any law, qualifies as a medical service”.

“Regrettably, gym rebates and wellness programmes offered by medical aid funds do not fall within the defined principle of a “medical service” and are not permissible by the governing law, hence the directive for the discontinuation of the said practice,” Matomola explained.
However, Alison Begley, principal officer of the NMC Fund, assured her members that they would discuss the issue directly with Namfisa in order to get clarity on their views and mandate according to the Medical Aids Funds Act (23 of 1995) read with the provisions of the Medical Aid Amendment (Act 11 of 2016).

In a statement on WhatsApp, Begley noted that the approach of the Namibian Association of Medical Aid Funds (Namaf) was to work towards amending the current provisions that render gym rebates (under the current laws) illegal.

However, Namaf has yet to respond to questions sent to it last week, saying it needs to consult all medical aids in the country before it responds.

“NMC is fully aware of and totally supports how gym rebates and healthy lifestyles impact on claims patterns.

“Therefore please rest assured that the industry and NMC is not taking this directive lying down, and we are seriously working on continuing to be able to promote healthy lifestyles and incentivising those members who are currently actively trying to maintain their good health,” Begley said.

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