Namaf to appeal High Court ruling
The Namibian Association of Medical Aid Funds (Namaf) is to appeal a High Court judgement that its member medical aid funds are not exempted from the jurisdiction of the Namibian Competition Commission (NaCC).
Namaf said the appeal to the Supreme Court is now under way and the operation and execution of the High Court order will be suspended pending the outcome of the appeal.
High Court Judge Collins Parker last month ruled that the NaCC as a statutory body has the power to administer and enforce the Competition Act, which includes investigating anti-competition conduct.
This followed an investigation by the NaCC in 2014 which found that Namaf and its member medical aid funds had conspired to fix prices in the form of benchmark tariffs for medical services.
Namaf contends that it does not entitle member organisations to profit from or share in the assets of their funds, stressing that these medical aid schemes are “not for gain”.
“The only purpose for which a medical aid fund scheme under the Medical Aid Funds Act exists, is to reimburse or pay for medical expenses to its members and their dependents incurred to the extent that they are entitled to such benefits under the relevant benefit option for which they (and often their employers) pay contributions,” Namaf stated in a newspaper advertisement.
It continues: “As the competition law of Namibia is to secure competition between undertakings carried on for the gain of their stakeholders, the medical aid funds were advised and hold the view that they do not fall to be treated as such undertakings and that they therefore do not fall under the jurisdiction of the competition commission.”
The challenge to codes and tariffs of Namaf members first arose from a formal complaint in 2011 by the NaCC and the Namibia Private Practitioners Fund (NPPF).
NPPF last week indicated that it is not opposed to setting “ethical tariffs” but says this cannot be done by one party. It also said it fully supports the NaCC’s position that an inclusive body be established by law to determine tariffs. Eben de Klerk of ISG Namibia last week said Namaf is not fulfilling its role as regulator of medical aid funds. He said Namaf, instead of being a regulator that protects the public against medical aid funds, in fact turned into a representative of these medical aid funds.
As things now stands, said De Klerk, there is a conflict of interest since the management of Namaf are in fact the medical funds themselves.
The Medical Aid Funds Act of 1995 stipulates that the management of Namaf “shall consist of seven members elected by the authorised representatives of registered funds amongst themselves.”
According to the Medical Aid Funds Act of 1995, Namaf is to “control, promote, encourage and coordinate the establishment, development and functioning of Medical Aid Funds in Namibia”.
In December 2011 the legal representatives of Namaf, LorentzAngula Inc, argued Namaf is not a statutory regulator of medical aid funds, a function it said falls to the Registrar of Medical Aid Funds.
De Klerk also took issue with the assertion in Namaf’s advertisement that the NPPF is a “small group of medical practitioners who joined together as the Keetmanshoop-based” organisation.
He pointed out that while NPPF’s chairperson lives in Keetmanshoop, the organisation is in fact Windhoek-based and that members of its executive are spread out across Namibia.
Moreover, he said, NPPF with its 313 members, actually forms the largest representative of healthcare professionals in the country.
CATHERINE SASMAN
Namaf said the appeal to the Supreme Court is now under way and the operation and execution of the High Court order will be suspended pending the outcome of the appeal.
High Court Judge Collins Parker last month ruled that the NaCC as a statutory body has the power to administer and enforce the Competition Act, which includes investigating anti-competition conduct.
This followed an investigation by the NaCC in 2014 which found that Namaf and its member medical aid funds had conspired to fix prices in the form of benchmark tariffs for medical services.
Namaf contends that it does not entitle member organisations to profit from or share in the assets of their funds, stressing that these medical aid schemes are “not for gain”.
“The only purpose for which a medical aid fund scheme under the Medical Aid Funds Act exists, is to reimburse or pay for medical expenses to its members and their dependents incurred to the extent that they are entitled to such benefits under the relevant benefit option for which they (and often their employers) pay contributions,” Namaf stated in a newspaper advertisement.
It continues: “As the competition law of Namibia is to secure competition between undertakings carried on for the gain of their stakeholders, the medical aid funds were advised and hold the view that they do not fall to be treated as such undertakings and that they therefore do not fall under the jurisdiction of the competition commission.”
The challenge to codes and tariffs of Namaf members first arose from a formal complaint in 2011 by the NaCC and the Namibia Private Practitioners Fund (NPPF).
NPPF last week indicated that it is not opposed to setting “ethical tariffs” but says this cannot be done by one party. It also said it fully supports the NaCC’s position that an inclusive body be established by law to determine tariffs. Eben de Klerk of ISG Namibia last week said Namaf is not fulfilling its role as regulator of medical aid funds. He said Namaf, instead of being a regulator that protects the public against medical aid funds, in fact turned into a representative of these medical aid funds.
As things now stands, said De Klerk, there is a conflict of interest since the management of Namaf are in fact the medical funds themselves.
The Medical Aid Funds Act of 1995 stipulates that the management of Namaf “shall consist of seven members elected by the authorised representatives of registered funds amongst themselves.”
According to the Medical Aid Funds Act of 1995, Namaf is to “control, promote, encourage and coordinate the establishment, development and functioning of Medical Aid Funds in Namibia”.
In December 2011 the legal representatives of Namaf, LorentzAngula Inc, argued Namaf is not a statutory regulator of medical aid funds, a function it said falls to the Registrar of Medical Aid Funds.
De Klerk also took issue with the assertion in Namaf’s advertisement that the NPPF is a “small group of medical practitioners who joined together as the Keetmanshoop-based” organisation.
He pointed out that while NPPF’s chairperson lives in Keetmanshoop, the organisation is in fact Windhoek-based and that members of its executive are spread out across Namibia.
Moreover, he said, NPPF with its 313 members, actually forms the largest representative of healthcare professionals in the country.
CATHERINE SASMAN
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Namibian Sun
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