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									                                                       Contents

Part 1. Strategic review for April 2004 – March 2005                      Part 3: Budget for 2004/2005

  1. Introduction                                                                1. Full budget
  2. Maintaining legitimacy of the Council for                                   2. Income budget 2004 / 2005
     Medical Schemes
  3. Fair Treatment of beneficiaries                                             3. Budget per unit
  4. Theme Projects for 2004 / 05                                                     a. Office of the CEO
  5. Improving our responsiveness to Stakeholders                                     b. Registration & accreditation unit
  6. Improving customer service                                                       c. Financial supervision unit
  7. Reviewing enforcement procedures                                                 d. Research and monitoring unit
  8. Aligning people processes to business goals                                      e. Compliance unit
  9. Budget for 2004 / 05                                                             f. Legal services unit
                                                                                      g. Complaints unit
Part 2. Regulatory plan for April 2004 – March 2005                                   h. Communication & education unit
                                                                                      i. Internal finance unit
  1. Registration and accreditation unit                                              j. Human resources development
                                                                                         unit
  2.   Financial supervision Unit                                                     k. Information technology unit
  3.   Research and monitoring unit
  4.   Compliance unit
  5.   Legal services unit
  6.   Complaints Unit
  7.   Communication and education unit
  8.   Internal finance unit
  9.   Human resources development unit
 10.   Information technology unit



                                                   Council For Medical Schemes
                                                   Regulatory plan and budget
                                                      2004/5 Financial Year
                                                                                                                      Page 2 of 64
                                  Part1: Strategic Review




                                               Part 1.

                              Strategic review




Council For Medical Schemes
Regulatory plan and budget
   2004/5 Financial Year
                                                Page 3 of 64
                                                                                                            Part1: Strategic Review

1. Introduction
             This regulatory plan covers the financial year 1 April          •    Bringing to finality the issues of demarcation between
             2004 to 31 March 2005. The regulatory plan sets out                  the business of medical schemes and that of other
             the CMS’s priorities and the budget. The plan is based               non-indemnity health insurance product, including firm
             on a strategic framework adopted by Council on 14/15                 regulatory action against parties that transgress the
             November 2003.                                                       demarcation divide;
                                                                             •    A review of governance failures within medical
             The key strands of the strategic plan include:                       schemes and possible responses to deal with these
                                                                                  issues and finally;
                  •   The need to develop a coherent vision for private      •    The issue of HIV/AIDS and prescribed minimum
                      health regulation to which all agencies of                  benefits as well as the continual development of an
                      government subscribe, in order attenuate                    appropriate regulatory framework in this regard.
                      potential regulatory gaps, inconsistencies and
                      conflict.   This    vision   should    encompass
                      competition policy in relation to private health
                      sector regulation and effective supply side
                      regulation;
                  •   Optimal implementation of the requirements for
                      designated service providers in the context of
                      prescribed minimum benefits;
                  •   Appropriate regulation of managed health care,
                      with a priority being placed on arrangements that
                      involve or purport to involve risk transfer. The
                      impact of other legislative measures such as the
                      Competition Act and the Medicines and Related
                      Substances Control Act on the development of
                      managed health care should also be taken into
                      account;




                                                    Council For Medical Schemes
                                                    Regulatory plan and budget
                                                       2004/5 Financial Year
                                                                                                                              Page 4 of 64
                                                                                                        Part1: Strategic Review

2. Maintaining legitimacy of the Council for Medical Schemes
              A key challenge for us this year will be to continue to Our risk based framework will continue to be underpinned by
              maintain and develop the legitimacy of the Council for the following key components:
              Medical Schemes. We consider CMS’ legitimacy to
              depend critically on two key pillars: the first source of  • First, we will continue to refine the categorization of
              legitimacy is, of course, the legislation and regulations      medical schemes into impact bands – low, medium and
              that establish our duties, functions and powers. The           high impact bands. A medical scheme will be allocated
              second relates to the effectiveness, efficiency and            to an impact band on the basis of the impact of failure
              integrity with which we discharge those functions and          of such a scheme would have on the environment that
              responsibilities.   Our effectiveness and efficiency           we regulate. We will continue to use the number of
              depend, in turn, on the clarity with which we set out our      members and pensioner ratios of schemes as the two
              strategic and operational plans, and the manner in which       key variables for the allocation of schemes into impact
              we report progress against them. This is the key               bands.
              purpose of this document.                                  • Second, we will continue with the development of Risk
                                                                             Assessment Frameworks (RAFs) for those schemes
              Our overall approach to the regulation of medical              identified as high impact. A RAF is our assessment of
              schemes remains unchanged. We will continue to build           the risks posed by individual schemes to our ability to
              on our risk based operating framework. This ‘problem-          achieve our statutory objectives. The key intention
              solving’ approach requires that we identify the ‘big           with the RAFs is to focus trustees and CMS’ attention
              problems’ within the medical schemes environment and           on the important risks, so that appropriate actions can
              develop solutions to these big problems.                       be taken.
                                                                         • Third, we will continue the development and
                                                                             implementation of Risk Mitigation Plans (RMPs) to
                                                                             respond to the scheme risks identified in the RAF.

                                                                       We will continue to be guided by our Principles of Good
                                                                       Regulations, including the need to be proportionate in the
                                                                       regulatory actions and tools that we use, and an acceptance
                                                                       that we can never put in place a zero failure regulatory
                                                                       regime.

3. Fair Treatment of beneficiaries

                                                  Council For Medical Schemes
                                                  Regulatory plan and budget
                                                     2004/5 Financial Year
                                                                                                                          Page 5 of 64
                                                                                                         Part1: Strategic Review

             We will also put a greater emphasis this year on          We will strengthen our regulatory focus on this aspect of
             implementing the recommendations made by our Fair         medical schemes responsibility, and we will make an
             Treatment of Beneficiaries Project. We expect Board of    assessment of fair treatment of beneficiaries an important part
             Trustees to give adequate priority to fair treatment of   of our regular monitoring of medical schemes and our risk
             members and their dependants when developing their        assessment and risk mitigation plans.
             information and marketing material, designing benefits
             and determining contributions, administration and
             governance of medical schemes and in strategies
             adopted for complaints and dispute resolutions.

4. Theme Projects for 2004 / 05
             We intend to continue our attempts to shift some of our   Our focus will span issues such as an assessment of causes of
             work towards thematic regulation. We learned a number     governance failures within medical schemes, the extent to
             of very valuable lessons during 2003/04 while working     which the current governance model or its’ misapplication
             on three theme projects, especially on the “Fair          contributes to any identified failures, and a review of
             Treatment of Beneficiaries.” We will continue our work    strategies to mitigate the risk of governance failure. The
             on two theme projects that were started during 2003/04    theme project will also investigate appropriate frameworks
             on the Development of the Risk Based Regulatory           and conditions that ought to be attached to CMS’ approval of
             Framework and on Managed Health Care and Risk             additional funding and loans to medical schemes.
             Transfer. We will also commence work on a new
             Governance theme project.




                                                 Council For Medical Schemes
                                                 Regulatory plan and budget
                                                    2004/5 Financial Year
                                                                                                                            Page 6 of 64
                                                                                                             Part1: Strategic Review



5. Improving our responsiveness to stakeholders
             We intend, during this year, to focus on improving our
             customer service, reviewing our enforcement procedures
             to ensure that they are as effective as they can be, and
             work on aligning the people processes at CMS to our
             operational and business goals

6. Improving customer service
             We aim to provide more accurate and prompt service to         We also intend to improve the efficiency with which we
             our customers, and to make it easier for medical              process applications for benefit and contribution changes,
             schemes and beneficiaries to deal with us. We will,           reinsurance and request for exemptions. We will conduct a
             during this year, refine further our own understanding of     comprehensive review of our complaints and dispute
             who we serve and whom we should expect to please by           resolution procedures in order to streamline them, taking into
             the regulatory actions that we take. Our regulatory           account the recommendations made at our Seminar on Fair
             activities necessarily involve many parties, some present     Treatment of Beneficiaries.       Finally, we will continue to
             in interactions with us and many not. In this context it is   consolidate the manner in which medical schemes and others
             important that we are absolutely clear about who are          report to us the data that we need, with the aim of making
             the parties that we are seeking to please. While we           our electronic statutory returns easier for medical schemes.
             believe that all parties that we deal with ought to be
             treated with respect and dignity, we are also keenly
             aware that many times the person(s) we seek to please
             may not be directly involved in a particular regulatory
             transaction.




                                                    Council For Medical Schemes
                                                    Regulatory plan and budget
                                                       2004/5 Financial Year
                                                                                                                               Page 7 of 64
                                                                                                              Part1: Strategic Review

7. Reviewing enforcement procedures
              As a regulator, we exert influence through our               We also intend to ensure that we maintain a balance between
              enforcement actions. It is becoming increasingly clear       the need for enforcement and our responsiveness to our
              that enforcement is principally about the messages that      stakeholders. We are aware that paying insufficient attention
              are given and the timing of such messages. For our           to stakeholder satisfaction may compromise our ability to
              messages to be effective, we have to find ways of            provide a responsive and high level service. We are
              shortening as much as possible while retaining fair          concerned, however, not to push the notion of stakeholder
              administrative procedure, the time between an event          satisfaction too far, or apply it to regulatory terrains where it
              taking place and any subsequent enforcement actions.         may not belong, as this may be equally perilous.
              At the moment this time is sometimes too long and lacks
              clarity and predictability, resulting in the impact of
              regulatory action being muted or misunderstood.




8. Aligning people processes to business goals
              We recognize that in order for us to be successful in        These themes will include people processes such as
              achieving the regulatory objectives that we have             performance management, remuneration, training, skills
              outlined here, we need to place our staff at the center of   development and succession planning; issues of cultures and
              our organizational purpose. We will work within a newly      values such as creating a positive environment for work
              constituted staff coalition called CMS ACTIVE to make        motivation, team work, management of diversity and non-
              progress on a number of themes that will allow us to         discrimination. In future our work within CMS ACTIVE will
              better align the context within which we work to our         focus on other themes such as the type of leadership and
              business goals.                                              top team that is needed for an organization such as ours and
                                                                           organizational structures that allow for the attainment of
                                                                           our business goals.




9. Budget for 2004 / 5
              The budget that we propose for 2004/05 has been The CMS’ focus has been evolving over the last few years as
              prepared in the light of our regulatory plan outlined our statutory responsibilities have been clarified, both as a
                                                    Council For Medical Schemes
                                                    Regulatory plan and budget
                                                       2004/5 Financial Year
                                                                                                                                 Page 8 of 64
                                                                                                             Part1: Strategic Review

               here. The full budget is outlined in part three. Our         result of government mandates and of the evolving and
               proposed budget for 2004/05 increases by 6% when             dynamic medical schemes environment. We hope that the
               taking into account our normal activities. The addition of   overall balance of activities that we have proposed will be
               the work on development of a National Reference Price        seen as a reasonable judgment in our effort to deliver on our
               List means that our final budget increases by 9%. The        statutory remit of enhancing protection of members and
               effect on levies charged will be a 5% increase to R9, 17     promoting the stability of medical schemes.
               from R8, 74 per member per year, or just over 76 cents
               per member per month.




T. PATRICK MASOBE
CEO – COUNCIL FOR MEDICAL SCHEMES
MARCH 2004




                                                     Council For Medical Schemes
                                                     Regulatory plan and budget
                                                        2004/5 Financial Year
                                                                                                                               Page 9 of 64
                                  Part2: Regulatory Plan




                                              Part 2.

                              Regulatory Plan




Council For Medical Schemes
Regulatory plan and budget
   2004/5 Financial Year
                                              Page 10 of 64
                                                                                                                Part2: Regulatory Plan
                                                                                                    Registration and Accreditation Unit


Registration and accreditation unit
Promote understanding of the medical schemes environment by trustees, beneficiaries and the public

OBJECTIVES                           ACTIVITIES                         OUTPUTS                              OUTCOME
Promote sound corporate              Participate in BOT Training         BoT Training workshops              Improved governance of
governance of medical schemes        Workshops as requested by                                               schemes by BOT’s
                                     Training Division

                                     Participate in workshops and       Workshops with brokers by
                                     group discussions with brokers,    August 2004, administrators by
                                     administrators and managed care    February 2005 and managed
                                     organizations                      care by March 2005
Ensure fair treatment of             Assist in reviewing the document   Q&A document finalized by 1          Better informed members
beneficiaries by determining         “Questions and Answers”            July 2004
minimum standards of
information provided to the public   Participate in developing                                               Information provided to members
                                     guidelines for completion of        Industry agreement on minimum       by schemes is simple,
                                     marketing material and              set of information to be given to   understandable and promotes
                                     application forms used by           members, by June 2004. Model        fairness
                                     medical schemes                     application forms, by July 2004
Assist with assessment of            Participate in theme project on     Theme project report, by July       Rules are consistent with
capitation arrangements              assessment of capitation            2004                                capitation contracts
                                     contracts
                                                                         50% of scheme rules reviewed
                                     Ensure that schemes rules are       for capitation contracts, by
                                     consistent with capitation          August 2004;
                                     contracts
                                                                         100% by December 2004



                                                           Council For Medical Schemes
                                                           Regulatory plan and budget
                                                              2004/5 Financial Year
                                                                                                                                   Page 11 of 64
                                                                                                              Part2: Regulatory Plan
                                                                                                  Registration and Accreditation Unit

Secure an appropriate level of protection for beneficiaries of medical schemes and the public by authorising the conduct of
medical scheme business

OBJECTIVES                         ACTIVITIES                         OUTPUTS                              OUTCOME
Ensure compliance by all schemes   Evaluate and process rule          40 % within 30 days of receipt       Compliance with policy decisions
in their rules with the Act,       amendments in terms of                                                  and regulatory framework
amended regulations and revised    diagrammatical process (See        40 % within two months of
model rules                        Annexure 1)                        receipt

                                                                      20 % within 3 months of receipt
                                                                      due to need for further
                                                                      interaction
                                   Interpret and guide stakeholders   Communication to stakeholders,       Certainty in application of law is
                                   re contents of model rules         as required                          achieved
                                   Communicate reasons for not        Upon registration of rules           Certainty in application of law is
                                   registering unacceptable rules                                          achieved
                                   and provide justifiable reasons    Within 7 days of analysis if rules
                                                                      are unacceptable for registration
                                   Manage amalgamation and            Report to Registrar for              Ensure compliance with relevant
                                   liquidation procedures in          confirmation within two weeks of     provisions upon amalgamation
                                   compliance with the expositions    application to appoint liquidator    between and dissolution of
                                   approved and prevailing            and submission of Liquidation        schemes
                                   legislation.                       and Distribution accounts
                                   Ensure submission by schemes of    Annexure 1 and 2 analysed and        Contribution and benefit changes
                                   Annexure 1 and 2 on                approved / registered by 30          are evaluated and approved prior
                                   contributions and benefit          November of each year                to implementation by schemes
                                   changes, by 30 September of
                                   each year




                                                         Council For Medical Schemes
                                                         Regulatory plan and budget
                                                            2004/5 Financial Year
                                                                                                                                   Page 12 of 64
                                                                                                                 Part2: Regulatory Plan
                                                                                                     Registration and Accreditation Unit

OBJECTIVES                          ACTIVITIES                            OUTPUTS                             OUTCOME
Establish electronic Scheme         Participate in EDMS / Knowledge       Technical specification document    Online submission of scheme
rules database as part of EDMS      Bank project team and contribute      and request for proposal on         rules
system                              to development of technical           EDMS/Knowledge Bank developed
                                    specification document and            and submitted for approval by       Electronically manage Financial
                                    request for proposal                  end of February 2005                Soundness of administrators
                                                                                                              entities and document retention
                                                                                                              of schemes data

                                                                                                              Shared information available
                                                                                                              electronically for management
                                                                                                              purposes
Assist Compliance with reviewing    Conduct an assessment of benefit      Quarterly report on compliance of   Compliance with legal
sustainability of benefit options   options based on quarterly            options with minimum                requirements
and taking appropriate action       reports of benefit options in order   membership within 4 weeks after
                                    to evaluate:                          receipt                             Avoid unnecessary proliferation of
                                                                                                              benefit options within schemes
                                    Adequacy of membership;
                                    proposed measures to effect
                                    changes to benefit design in
                                    respect of identified schemes




                                                           Council For Medical Schemes
                                                           Regulatory plan and budget
                                                              2004/5 Financial Year
                                                                                                                                     Page 13 of 64
                                                                                                           Part2: Regulatory Plan
                                                                                               Registration and Accreditation Unit

Foster compliance with the act by managed care organisations

OBJECTIVES                        ACTIVITIES                          OUTPUTS                          OUTCOME
Effect accreditation of managed   Ensure submission of applications    100% accredited by March 2004   Accreditation in compliance with
care organisations                as determined                                                        MSA

                                  Evaluation of applications in                                        Create safe environment for
                                  conjunction with R&M.                                                schemes to contract for specified
                                                                                                       services
                                  Coordinate meetings of Council
                                  Sub-committee to review
                                  applications

                                  Prepare recommendations for
                                  Council approval.




                                                         Council For Medical Schemes
                                                         Regulatory plan and budget
                                                            2004/5 Financial Year
                                                                                                                             Page 14 of 64
                                                                                                                 Part2: Regulatory Plan
                                                                                                     Registration and Accreditation Unit


Foster compliance with the act by broker and broker organisations

OBJECTIVES                           ACTIVITIES                         OUTPUTS                              OUTCOME
Ensure accreditation of brokers in   Review and process applications    60 % of applicants for               All brokers are accredited in
terms of Act                         for accreditation of brokers       accreditation or renewal within 30   terms of the Act
                                                                        days of receipt;
                                     Maintain database for broker
                                     accreditation                      100% within 60 days of receipt
                                                                        due to further interaction.
                                     Renewal notification
                                     Advisory services
                                     Render assistance to Compliance    Report, jointly with Compliance,     Ensure compliance with Medical
                                     on request with respect to         on possible suspensions /            Schemes Act.
                                     suspension/withdrawal of           withdrawals of accreditation.
                                     accreditation
                                     Liaison with FSB to ensure         Scheduled meetings of Task           Ensure compliance with FAIS and
                                     consistency with FAIS              Team at least once every 3           MSA
                                                                        months




                                                           Council For Medical Schemes
                                                           Regulatory plan and budget
                                                              2004/5 Financial Year
                                                                                                                                    Page 15 of 64
                                                                                                                Part2: Regulatory Plan
                                                                                                    Registration and Accreditation Unit

Foster compliance with the act by administrators
OBJECTIVES                        ACTIVITIES                           OUTPUTS                               OUTCOME
Accreditation of Administrators   Manage performance by                Reports on administrator              Administrators function in terms
                                  contractor in accordance with        accreditation for approval by         of regulatory standards
                                  targets set in tender document &     Council
                                  through participation in Steering
                                  Committee
                                  Evaluation of reports by Steering    Accreditation to all bona fide
                                  Committee and preparing              administrators by end of April
                                  recommendations for Council          2004
                                                                       100% accredited by February
                                                                       2005 based on contractor
                                                                       evaluation
                                   Review results and identify areas   Reports on possible
                                   for improving accreditation         improvements
                                   criteria
Ensure compliance by              Ensure submission of                 Submission of Regulation 25           Administrators are financially
administrators with the           management representation            annual reports within 4 months        sound
requirements for accreditation    letters and annual audit reports     after administrators financial year   Administrators function in terms
                                  on systems of internal financial     end                                   of regulatory standards
                                  control and annual financial
                                  statements of administrators
                                   Evaluate reports and make           Evaluation completed within 3
                                   recommendations re continued        months of receipt of relevant
                                   accreditation status if required.   documents




                                                         Council For Medical Schemes
                                                         Regulatory plan and budget
                                                            2004/5 Financial Year
                                                                                                                                   Page 16 of 64
                                                                                                                   Part2: Regulatory Plan
                                                                                                                Financial Supervision Unit
Financial Supervision Unit
Secure an appropriate level of protection for beneficiaries of medical schemes and the public by monitoring financial
performance and promoting financial soundness of schemes

OBJECTIVES                         ACTIVITIES                           OUTPUTS                              OUTCOME
Help improve standard of medical   Training of administrators to        Administrators workshops             Improved quality of standardized
schemes’ reporting                 discuss the preparation of           - 2 workshop (April)                 reports by medical schemes
                                   financial statements, projections,   - 1 workshops (Jan 2005)
                                   budget etc.

Help improve the integrity of      Provide assistance to R & A in the   Recommendation on evaluation of      Improved systems of internal
controls and systems of the        evaluation of the reports to be      Annexure C1 report in terms of       controls amongst accredited
administrators                     submitted by the administrators      Regulation 17 (2)(d)                 administrators
                                   in terms of Regulation 17 and 25     (Accreditation of Administrators).

                                                                        Recommendation on evaluation of
                                                                        Annexure C2 (Annual Financial
                                                                        reports) and Annexure D
                                                                        (Management representation
                                                                        letter) in terms of Regulation 25.

Help ensure the financial          Provide assistance to R&A on the     Recommendation on the financial      Financial Soundness of
soundness of the administrator     financial soundness of the           soundness of the administrator       administrators
                                   administrator (Regulation 22).       (Regulation 22).




                                                          Council For Medical Schemes
                                                          Regulatory plan and budget
                                                             2004/5 Financial Year
                                                                                                                                      Page 17 of 64
                                                                                                                    Part2: Regulatory Plan
                                                                                                                 Financial Supervision Unit
Promote financial stability, soundness and sustainability of medical schemes
OBJECTIVES                           ACTIVITIES                            OUTPUTS                            OUTCOME
Improve statutory returns as tools   Identify and document changes         Refined statutory returns          Improve availability of data for
for reporting                        to statutory returns to incorporate                                      sound decision making (both
                                     changes in accounting standards,                                         regulatory and scheme
                                     legislation and to be more user                                          management).
                                     friendly.

                                     Consultation with SAICA Medical
                                     schemes Project Group in respect
                                     of identified changes.
                                     Quarterly returns.                    Quarterly returns (Feb/Mar 2004;   Trustees are able to review
                                                                           Feb/Mar 2005)                      financial performance of their
                                                                                                              schemes on an ongoing basis.
                                     Annual return – 2003/4.               Annual return (Dec 2003/Jan
                                                                           2004; Dec 2004/Jan 2005)
                                     Disseminate 2003/2004 on-line         Annual return available to
                                     annual statutory return.              industry for completion
                                     Analysis of Returns:                  Report 6 weeks after official
                                     - Quarterly                           submission date of return.
                                     - Annual                              Annual report June 2004
Enhance appreciation                 Define total claims.                  Shadow solvency report             Better understanding of
/understanding of factors that                                             (Sept/October 2004)                differences in calculation of
impact on financial soundness of     Calculate ‘shadow solvency’ based                                        solvency and impact on industry
schemes.                             on total claims using Dec 2003                                           solvency.
                                     statutory return data




                                                            Council For Medical Schemes
                                                            Regulatory plan and budget
                                                               2004/5 Financial Year
                                                                                                                                     Page 18 of 64
                                                                                                                  Part2: Regulatory Plan
                                                                                                               Financial Supervision Unit
OBJECTIVES                          ACTIVITIES                          OUTPUTS                              OUTCOME
Improve Audit and Accounting        Liaise with SAICA and assess the    Revised Audit and Accounting         Enhanced financial reporting
guide issued by SAICA               amendments to the Act and           Guide.                               based on updated legislation and
                                    Regulations and Accounting and                                           accounting standards reflected in
                                    Audit standards to ascertain the                                         the guide.
                                    impact on the content of Audit
                                    and Accounting guide for medical
                                    schemes
Monitor the financial soundness     Identifying of schemes non-         Compile a report listing the         Improved financial position and
of medical schemes.                 compliant with Regulation 29        schemes non-compliance with          performance of the medical
                                    using the returns and supporting    Regulation 29                        schemes.
                                    documents
                                    Examine and evaluate                Compile and provide a
                                    methodically and in detail the      recommendations report for
                                    structure and elements of the       implementation of an action plan
                                    business plan in order to assess    in respect of continuous
                                    the true financial position and     adherence to the Act.
                                    performance of the medical          Monitoring meetings with the BoT
                                    schemes.                            to ensure compliance with the
                                                                        action plan.
Assist in ensuring compliance       Assessment/analysis of the          Preparation of a recommendation      Improved levels of compliance.
mainly with the financial aspects   following applications received     report in respect of the following
of the Act.                         from schemes:                       applications received from
                                                                        schemes:
                                    -   Auditor approval;
                                    -   Reinsurance contracts;          - Auditors’ approval;
                                    -   Exemptions from the             - Reinsurance contracts.
                                        provisions of the Act           Preparation of a report assessing
                                    -   New schemes                     the financial implications of:
                                    -   Amalgamations
                                                                        - Exemptions from the provisions
                                                                          of the Act
                                                                        - New schemes

                                                           Council For Medical Schemes
                                                           Regulatory plan and budget
                                                              2004/5 Financial Year
                                                                                                                                   Page 19 of 64
                                                                                                               Part2: Regulatory Plan
                                                                                                            Financial Supervision Unit
OBJECTIVES                         ACTIVITIES                          OUTPUTS                            OUTCOME
                                                                       - Amalgamations

                                                                                                          Improve levels of compliance.
                                                                       Compile and review of standard
                                   Assessment of investment
                                                                       checklist.
                                   products in order to understand
                                   the nature of it; and evaluating
                                   compliance with the Act.
Ensure that financial guidelines   Review:                             Reviewed standard                  Improved standard
used by CMS are up to date.        - auditor approval                  documentation to be maintained     documentation to be used by
                                   - standard business plans           on the website                     medical schemes.
                                   - standard management
                                       accounts and standard
                                       reinsurance guidelines.

Assist in ensuring that the        Assessment of financial impact of   Preparation of recommendation in   Improve financial soundness of
schemes benefit options are        new benefit options and changes     respect of new benefit options     the benefit options in a medical
financially sound.                 to existing options                 and changes to existing options    scheme.

                                   Examine and evaluate
                                   methodically and in detail the      Compile and provide a report on
                                   structure and elements of the       the financial soundness of every
                                   business plan in order to assess    option in the scheme to R&A and
                                   the true financial position and     Compliance, for implementation
                                   performance of the benefit          of and action plan in respect of
                                   options of the scheme.              continuous adherence to the Act
                                                                       with regard to the schemes
                                                                       benefit options.

Assist in instituting routine      Assist in conducting the            Assist in preparation of the       Scheme management is
inspections of selected schemes.   inspections.                        inspection report                  improved.



                                                          Council For Medical Schemes
                                                          Regulatory plan and budget
                                                             2004/5 Financial Year
                                                                                                                                 Page 20 of 64
                                                                                                               Part2: Regulatory Plan
                                                                                                            Financial Supervision Unit
Provide support and guidance to trustees, and promote understanding of the medical schemes environment by trustees,
beneficiaries and the public

OBJECTIVES                       ACTIVITIES                            OUTPUTS                           OUTCOME
Promote good governance in the   Assist in the development of          Guidelines                        Improved governance of
medical schemes industry         governance guidelines                                                   schemes’ fund by trustees.
                                 Development and enhancement           Enhanced financial chapters for   Improved financial understanding
                                 of the financial guidelines for the   the BoT manual.                   of schemes by BoTs
                                 Board of Trustees manual.
Contribute to BoT training on    Prepare and present modules on        Number of modules presented as    Increased capacity by BoTs for
financial issues                 financial management of schemes       per training targets (one a       financial management of
                                 to BoTs at training workshops.        quarter).                         schemes.

                                 Take part in Registrar’s annual       Number of presentations at road
                                 road shows with BoTs.                 shows as per corporate targets.




                                                        Council For Medical Schemes
                                                        Regulatory plan and budget
                                                           2004/5 Financial Year
                                                                                                                               Page 21 of 64
                                                                                                              Part2: Regulatory Plan
                                                                                                        Research and Monitoring Unit

Research and monitoring unit
Secure an appropriate level of protection for beneficiaries of medical schemes and the public by authorising the conduct of
medical schemes business and monitoring the financial performance and soundness of medical schemes

OBJECTIVES                        ACTIVITIES                          OUTPUTS                           OUTCOME
Clinical support in relation to   Rendering of clinical advice and    Advice provided on request of     Appropriate evidence based rules
registration of scheme rules      support rendered per request        R&A, within one week of request
                                  received                            being made




                                                         Council For Medical Schemes
                                                         Regulatory plan and budget
                                                            2004/5 Financial Year
                                                                                                                              Page 22 of 64
                                                                                                               Part2: Regulatory Plan
                                                                                                         Research and Monitoring Unit

Provide support and guidance to trustees and promote understanding of the medical schemes environment by trustees,
beneficiaries and the public.

OBJECTIVES                    ACTIVITIES                           OUTPUTS                               OUTCOME
Promotion of Access to        Processing of all requests in terms Full compliance with POATIA in         Greater accessibility of
Information Act               of POATIA                           respect of handling of requests,       information to consumers and
                                                                  publication of manuals and             stakeholders
                              Update POATIA manual (if            notices, and provision of statistics
                              necessary)

                              Send statistics to South African
                              Human Rights Commission
                              Update section 15 notice




                                                     Council For Medical Schemes
                                                     Regulatory plan and budget
                                                        2004/5 Financial Year
                                                                                                                              Page 23 of 64
                                                                                                                  Part2: Regulatory Plan
                                                                                                            Research and Monitoring Unit

Investigate and resolve complaints raised by beneficiaries and the public

OBJECTIVES                          ACTIVITIES                          OUTPUTS                             OUTCOME
Clinical support in resolution of   Rendering of clinical advice and    Advice provided on request of the   Clinically appropriate resolution of
complaints                          support rendered per request        Complaints Division, within one     complaints, resulting in greater
                                    received                            week of request being made          health protection for consumers




                                                           Council For Medical Schemes
                                                           Regulatory plan and budget
                                                              2004/5 Financial Year
                                                                                                                                    Page 24 of 64
                                                                                                                 Part2: Regulatory Plan
                                                                                                           Research and Monitoring Unit

Monitor the impact of the Act, research developments and recommend policy options to improve the regulatory environment.

OBJECTIVES                        ACTIVITIES                           OUTPUTS                             OUTCOME
Monitoring the impact of the      Review of content of returns         Returns revised to accommodated     Appropriate data collection by the
Medical Schemes Act and trends    Analysis & reports on non            REF requirements – subject to       office to meet policy and
in Private Health Finance         accounting portions of 1/4ly &       REF process                         regulatory needs
                                  annual returns
                                                                       Analysis and report of non-         Better informed industry and
                                                                       accounting portions of annual and   public
                                                                       1/4ly returns, and preparation of
                                                                       write-up on this analysis for
                                                                       annual report, subject to
                                                                       timeframes determined by FSU
                                                                       and Communications

Monitoring of the impact of the   Publication of a tender document     A report with assessment and        Improved understanding of the
designated service provider       to invite tenders for assessment     recommendations in respect of       impact of DSPs and CDL, and
legislation and the CDL           of the impact of the chronic         the impact of DSP regulations and   optimal responsiveness to
                                  disease list and DSPs on financial   CDL on members and medical          problems experienced
                                  soundness, benefit design, access    schemes by end July 2004, with
                                  to care and adequacy of selected     mechanisms in place for ongoing
                                  DSPs by mid April 2004               monitoring

                                  Award of tender by end May 2004
                                  Close contract management and
                                  participation in research
                                  processes

                                  Presentation of preliminary report
                                  to Council by mid August 2004


                                                         Council For Medical Schemes
                                                         Regulatory plan and budget
                                                            2004/5 Financial Year
                                                                                                                                  Page 25 of 64
                                                                                                                 Part2: Regulatory Plan
                                                                                                           Research and Monitoring Unit

OBJECTIVES                        ACTIVITIES                           OUTPUTS                             OUTCOME
                                  Communication of results and
                                  preliminary recommendations by
                                  end September 2004
Monitoring affordability issues   Data abstraction from rule           Report on extent of contribution    Informed policy and decision-
within medical schemes            amendments, and analysis of          increases from 2003 to 2004, by     making
                                  data on contribution changes         end March 2004

                                                                       Report on extent of contribution
                                                                       increases from 2004 to 2005, by
                                                                       end March 2005
Review of minimum benefit         Defining and ICD 10 coding of        Existing package ICD 10 coded by    An affordable, marketable priority
package and supplementary         existing PMB package                 end December 2004                   list of conditions consistent with
benefit option structures                                                                                  the proposed risk equalisation
                                  Revisit PMB inclusion criteria and   Concept document on feasibility     framework, comprising a revised
                                  review of package consistent with    and proposals for a standardized    minimum benefit package
                                                                       set of benefit option packages by
                                  REF direction, including:            March 2005                          Greater standardisation of
                                                                                                           supplementary option packages
                                  Literature reviews                   Revised definition of basic         to facilitate consumer choice,
                                                                       package of benefits by December     comparability of cost and benefit
                                  Consultative fora                    2005                                structures, and enhanced
                                                                                                           competition on price and provider
                                  Technical review team                                                    options

                                  International consultative visit

                                  Development of the concept of a
                                  standardised set of benefit option
                                  packages

                                                          Council For Medical Schemes
                                                          Regulatory plan and budget
                                                             2004/5 Financial Year
                                                                                                                                  Page 26 of 64
                                                                                                                      Part2: Regulatory Plan
                                                                                                                Research and Monitoring Unit

OBJECTIVES                            ACTIVITIES                            OUTPUTS                             OUTCOME
Review process for the CDL            Establishment of a specialist         Gazetting of modifications to the   CDL algorithms which are at all
algorithms                            review committee to consider          CDL algorithms as and when          times up to date, state-of-the-art
                                      representations made by               required                            and evidence-based
                                      interested parties in respect of
                                      inadequacies in the algorithms by
                                      April 2004
                                      Formulation of initial
                                      recommendations to the Minister
                                      for modification of the algorithms,
                                      if necessary, by December 2004
                                      Continuation of review committee
                                      process on an ongoing basis
National Health Reference Price       Manage process required for the       Maintenance of 2004 NHRPL           Administrative efficiency through
List                                  development of the NRPL                                                   a benchmark price list
                                                                            Publication of 2005 NRPL by
                                                                            August 2004

                                                                            Maintenance of 2005 NRPL
Investigation into drivers of         Research by means of literature       Report on hospital costs and        Greater understanding of cost
medical inflation: Part 1 (Hospital   review, interviews, focus group       pricing to Council by March 2005    drivers with a view to ensuring
Costs)                                discussion and contract review                                            effective market or regulatory
                                      issues relating to hospital costs                                         interventions where appropriate
                                      which negatively impact on                                                to reduce levels of cost escalation
                                      medical schemes and
                                      mechanisms to mitigate this
                                      impact from a scheme, hospital
                                      group and regulatory perspective



                                                             Council For Medical Schemes
                                                             Regulatory plan and budget
                                                                2004/5 Financial Year
                                                                                                                                       Page 27 of 64
                                                                                                          Part2: Regulatory Plan
                                                                                                    Research and Monitoring Unit

OBJECTIVES               ACTIVITIES                            OUTPUTS                              OUTCOME
Regulatory development   Follow-up on recommendations          A draft set of regulatory and        A more effective and responsive
                         for extension of HIV PMB to           statutory amendments submitted       regulatory framework
                         include HAART to facilitate           to the Minister for consideration
                         promulgation                          by end October 2004,
                                                               incorporating:
                         Review of legislative impact,
                         internal and external consultation,          technical improvements
                         identification of anomalies and
                         problem areas, culminating in                REF framework (subject to
                         CMS breakaway to consider                    policy processes)
                         recommendations for statutory
                         and regulatory amendments by                 NRPL framework
                         end April 2004                               (depending on National
                                                                      Health Bill passage)
                         Consultative workshops on
                         proposed amendments by end            Publication of undesirable
                         June 2004                             business practice declarations, as
                                                               required
                         Formalisation of
                         recommendations for
                         amendments as submission to the
                         Minister of Health for introduction
                         in 2005, by end October 2004

                         Finalisation of REF legislative
                         framework, subject to policy
                         processes in relation to REF

                         Publication of undesirable
                         business practice declarations as

                                                 Council For Medical Schemes
                                                 Regulatory plan and budget
                                                    2004/5 Financial Year
                                                                                                                          Page 28 of 64
                                                                                                               Part2: Regulatory Plan
                                                                                                         Research and Monitoring Unit

OBJECTIVES                  ACTIVITIES                           OUTPUTS                                 OUTCOME
                            possible outcome of governance
                            project

                            Development of NRPL regulations
                            in conjunction with DOH,
                            contingent on enactment of
                            National Health Bill
Appropriate regulation of   In consultation with Dept of         Presentation of coherent strategy       Resolution to long-standing
Bargaining Council Funds    Labour, development of a             document for consideration by           uncertainty, and appropriate
                            strategy document on LRA             Ministers of Health and Labour by       protection to low cost funding
                            schemes based on legal opinion       November 2004                           environment
                            on legal status by mid May 2004

                            situational analysis by end August
                            2004

                            implementation strategies by end
                            October 2004
Managed Health Care         Consolidation of office and          Consensus document of Council           Accreditation of managed care
                            Council viewpoints on issues         on definitional issues in relation to   organizations consistent with
                            pertaining to managed care,          managed health care and                 appropriate policy framework
                            supplemented by appropriate          regulatory direction by end July
                            literature reviews                   2004

                            Continued participation in           Accreditation of managed care
                            managed care accreditation           organisations as per regulatory
                            review processes, as per R&A         framework informed by
                            targets                              appropriate research and policy
                                                                 inputs, as per R&A requirements

                                                   Council For Medical Schemes
                                                   Regulatory plan and budget
                                                      2004/5 Financial Year
                                                                                                                                Page 29 of 64
                                                                                                                Part2: Regulatory Plan
                                                                                                          Research and Monitoring Unit

OBJECTIVES                        ACTIVITIES                            OUTPUTS                             OUTCOME
Industry-wide implementation of   Ongoing participation and             Mandated use of ICD10 wef 2005, Greater efficiency through more
ICD10                             leadership in ICD 10 task team to     subject to appropriate exceptions standardisation of billing practices
                                  fast-track industry readiness for                                       and data collection
                                  ICD10 and prepare for industry-
                                  wide implementation considering
                                  operational, technical and training
                                  issues




                                                         Council For Medical Schemes
                                                         Regulatory plan and budget
                                                            2004/5 Financial Year
                                                                                                                                   Page 30 of 64
                                                                                                                      Part2: Regulatory Plan
                                                                                                                Research and Monitoring Unit

Foster the continued development of the CMS as an employer of choice.

OBJECTIVES                              ACTIVITIES                          OUTPUTS                             OUTCOME
Effective management of                 Efficient management of             Provision of high quality library   An informed and data rich
information                             Resource Centre including           and information retrieval service   working environment
                                        procurement, cataloguing,           to staff and Council, on an
                                        information provision,              ongoing basis
                                        management of information
                                        requests in terms of Promotion of
                                        Access to Information Act
Support IT in investigating             Participate in feasibility          Report to SMM on options,           A more efficient and customer
feasibility of options for electronic   assessment conducted by IT          subject to IT timeframes            friendly workplace
data management




                                                              Council For Medical Schemes
                                                              Regulatory plan and budget
                                                                 2004/5 Financial Year
                                                                                                                                      Page 31 of 64
                                                                                                             Part2: Regulatory Plan
                                                                                                       Research and Monitoring Unit

Develop strategic alliances nationally, regionally and internationally.

OBJECTIVES                       ACTIVITIES                        OUTPUTS                             OUTCOME
HPCSA liaison committee          Continued participation in        Defined by the process              Greater regulatory coordination
                                 CMS/HPCSA liaison committee
                                                                   Broaden plan for interaction with
                                                                   them




                                                      Council For Medical Schemes
                                                      Regulatory plan and budget
                                                         2004/5 Financial Year
                                                                                                                             Page 32 of 64
                                                                                                                      Part2: Regulatory Plan
                                                                                                                            Compliance Unit

Compliance unit
Foster compliance with the act by medical schemes, administrators and brokers and initiate enforcement action where
required.

OBJECTIVES                         ACTIVITIES                             OUTPUTS                              OUTCOME
Full inspection of non compliant   Inspection triggered by auditor        Initiate inspection within 10 days   Plan to ensure compliance of
schemes                            interviews, market intelligence,       of concerns being raised.            scheme.
                                   financial or governance concerns.
Assist FSU with non compliance     Invoke appropriate regulatory          Regulatory action specified in       Improved level of solvency.
with solvency requirements         action specified in solvency triage,   solvency triage to be effected
                                   where schemes fail to meet             within 30 days of solvency
                                   solvency.                              assessment.
Review sustainability of benefit   Conduct an assessment of benefit       Regulatory action within 45 days     Compliance with minimum
options                            options in respect of adequacy of      of assessment to ensure              requirements.
                                   membership & financial                 compliance
                                   soundness based on quarterly                                                Avoid unnecessary proliferation of
                                   reports.                                                                    benefit options.

                                   Propose measures to effect
                                   compliance with minimum
                                   requirements.
Put reinsurance practice on a      Finalise regulatory action on          As per FSU targets.                  More appropriate use of
stronger footing                   reinsurance contracts.                                                      reinsurance and compliance with
                                                                                                               reinsurance guidelines.
Ensure compliance with             Review of existing products            Existing products by June 2004,      Insurers and schemes complying
demarcation agreement              determined as important, and           new products within 3 months of      with demarcation agreement.
                                   review applications for new            becoming aware thereof.
                                   products.



                                                           Council For Medical Schemes
                                                           Regulatory plan and budget
                                                              2004/5 Financial Year
                                                                                                                                      Page 33 of 64
                                                                                                               Part2: Regulatory Plan
                                                                                                                     Compliance Unit

OBJECTIVES                         ACTIVITIES                         OUTPUTS                           OUTCOME
Ensure schemes comply with         Routine inspection of 5 medical    Inspection of schemes from Aug    Adherence to the Regulations
commission payments to brokers     schemes to check for compliance    to Oct 2004.                      regarding commission.
                                   with broker commission
                                   payments.                          Prosecution of non-compliance.
To enforce rulings made by the     Review rulings made by             Schemes implementing Registrar’s Adherence to rulings.
Registrar, including persistent    Complaints with the view to        rulings.
non-adherence                      enforcing same.

                                   Advise Legal Services of           Monthly memorandum to Legal
                                                                                                        Persistent non-adherence to
                                   persistent non-adherence for       Services.
                                                                                                        rulings is dropped.
                                   possible court action
Promote awareness of code of       Provide a compliance module for    July 2004.                        Adherence to the code of conduct
conduct for brokers and enforce    broker training.                                                     by brokers – satisfied members.
compliance therewith
Provide prompt advice on code of   Provide advice to stakeholders     Within 72 hours of request for    Awareness of conduct by public.
conduct                            regarding code of conduct.         advice.




                                                         Council For Medical Schemes
                                                         Regulatory plan and budget
                                                            2004/5 Financial Year
                                                                                                                               Page 34 of 64
                                                                                                             Part2: Regulatory Plan
                                                                                                                   Compliance Unit

Promote guidance and support to trustees, and promote an understanding of the medical schemes environment by trustees,
beneficiaries and the public of the medical schemes environment.

OBJECTIVES                           ACTIVITIES                           OUTPUTS                      OUTCOME
To provide training on the           Participation in trustee training.   BoT workshops per training   Trustees with knowledge & grasp
compliance priorities to Boards of                                        targets.                     of legal implications of
Trustees                                                                                               trusteeship.

                                                                                                       Improved standard of governance
                                                                                                       of medical schemes.




                                                             Council For Medical Schemes
                                                             Regulatory plan and budget
                                                                2004/5 Financial Year
                                                                                                                            Page 35 of 64
                                                                                                                   Part2: Regulatory Plan
                                                                                                                         Compliance Unit

Investigate and resolve complaints raised by beneficiaries and the public.

OBJECTIVES                         ACTIVITIES                          OUTPUTS                              OUTCOME
To conduct disciplinary hearings   Review disciplinary procedure       Enforceable disciplinary             Compliance with the Act,
for broker infringements of the    manual with Legal Services to       procedures manual by April 2004.     Regulations and code of conduct
Regulations and code of conduct    ensure it complies with the Act                                          by brokers.
                                   and Regulations.                    Council sub-committee by July
                                                                       2004.
To conduct disciplinary hearings   Lead investigations regarding       Number of disciplinary hearings in   Compliance with the Act,
for broker infringements of the    disciplinary enquiries as per       a priority area.                     Regulations and code of conduct.
Regulations and code of conduct    compliance themes and priorities.




                                                          Council For Medical Schemes
                                                          Regulatory plan and budget
                                                             2004/5 Financial Year
                                                                                                                                  Page 36 of 64
                                                                                               Part2: Regulatory Plan
                                                                                                     Compliance Unit

Develop strategic alliances nationally and internationally.

OBJECTIVES                         ACTIVITIES                          OUTPUTS           OUTCOME
Assist Legal Services with         With Legal Services enter into      Finalised MoUs.   Increased co-operation between
establishing a relationship with   discussions with SARS and                             regulatory bodies
specialist regulatory bodies       Scorpions to develop MoU.




                                                          Council For Medical Schemes
                                                          Regulatory plan and budget
                                                             2004/5 Financial Year
                                                                                                              Page 37 of 64
                                                                                                              Part2: Regulatory Plan
                                                                                                                 Legal Services Unit

Legal services unit
Provide support and guidance to trustees and promote understanding of the medical schemes environment by trustees,
beneficiaries and the public

OBJECTIVES                    ACTIVITIES                           OUTPUTS                             OUTCOME
Promote sound corporate       Participation in trustee training.   Presentations at:                   Improved governance of medical
governance amongst board of                                        Bot workshops per training          schemes.
trustee members.                                                   targets.
                                                                                                       Trustees with sound knowledge &
                                                                                                       grasp of legal implications and
                                                                                                       fiduciary responsibility of
                                                                                                       trusteeship.
Fair treatment project        Review of model rules to ensure      Model rules that comply with king   Full member participation on
                              compliance with king ii report &     ii report & other literature on     scheme matters;
                              international literature on          member participation;
                              member participation;

                              Review of model rules to include     Model rules that include specific   Members in a position to act in
                              specific grievance procedures for    grievance procedures for            accordance with specific
                              members unhappy with election        members unhappy with election       grievance procedures if unhappy
                              and decision-making processes in     and decision-making process in      with election and decision making
                              agm.                                 agm/ bot                            process in agm.




                                                      Council For Medical Schemes
                                                      Regulatory plan and budget
                                                         2004/5 Financial Year
                                                                                                                             Page 38 of 64
                                                                                                                     Part2: Regulatory Plan
                                                                                                                        Legal Services Unit

To identify areas of non-compliance and institute appropriate remedial measures

OBJECTIVES                         ACTIVITIES                             OUTPUTS                             OUTCOME
Review section 46 & obtain legal   Initiate legal proceedings for a       Judicial pronouncement on sect.     Clarity on sect. 46 process and
clarity                            declarator on section 46 process.      46 process.                         powers of the council.
                                   Revision of section 46.

Support fais task team             Rendering technical legal support      Advice on legal interpretation of   Creation of certainty in relation to
                                   to the task team on the fais act.      the relationship between medical    application of the fais & medical
                                                                          s. Act & fais act.                  schemes act.




                                                             Council For Medical Schemes
                                                             Regulatory plan and budget
                                                                2004/5 Financial Year
                                                                                                                                      Page 39 of 64
                                                                                                                      Part2: Regulatory Plan
                                                                                                                         Legal Services Unit

Securing an appropriate level of protection for beneficiaries of medical schemes & the public by authorizing the conduct of
medical schemes business & monitoring financial performance & soundness of schemes.

OBJECTIVES                        ACTIVITIES                            OUTPUTS                                OUTCOME
Enforce compliance with the act   Render legal advice & assistance      New registrations which accord         Schemes registered in accordance
                                  on registration of medical            with legislative provisions & policy   with the act.
                                  schemes & the accreditation of        directives.
                                  intermediaries.
                                  Render technical legal assistance     Amendment of rules in                  Rule amendments in accordance
                                  on rule amendments.                   accordance with legislative            with the act.
                                                                        provisions & policy directives.
                                  Render legal advice to the            Resolution of disputes in              Properly resolved disputes in
                                  registrar & council in instances of   accordance with the act & other        accordance with the act.
                                  disputes concerning registration      relevant legislation.
                                  of schemes & rule amendments.




                                                          Council For Medical Schemes
                                                          Regulatory plan and budget
                                                             2004/5 Financial Year
                                                                                                                                      Page 40 of 64
                                                                                                             Part2: Regulatory Plan
                                                                                                                Legal Services Unit

Investigating and resolving complaints raised by beneficiaries and the public

OBJECTIVES                          ACTIVITIES                          OUTPUTS                       OUTCOME
Render support to complaints unit   Render support & advice on          Legally sound & enforceable   Members’ satisfaction &
                                    complaints of a complex legal       rulings.                      confidence in the council.
                                    nature.
                                                                        Prompt turn around times in   Improved protection of members
                                    Take responsibility for appeals     resolution of complaints.
                                    brought before council.




                                                           Council For Medical Schemes
                                                           Regulatory plan and budget
                                                              2004/5 Financial Year
                                                                                                                             Page 41 of 64
                                                                                                                         Part2: Regulatory Plan
                                                                                                                            Legal Services Unit

Render legal support to various units

OBJECTIVES                           ACTIVITIES                             OUTPUTS                              OUTCOME
Provide legal support to the         Contracts;                             Efficient and effective policies &   Proper delivery of service to the
registrar & the council /                                                   procedures.                          industry.
operational units in the office of   Labour relations;
the registrar.                                                              Render advice to the other units     Strengthening relationship
                                     Policy & procedures;                                                        between the council & health-care
                                                                                                                 providers->
                                     Applicable legislation;
                                                                                                                 Hasa com-plaint “set-off”;
                                     Tender committee;                                                           Dr’s com-plaints various “set-
                                                                                                                 off”;
                                     Render secretarial support to
                                     exco & council;                                                             Widening cleft between service
                                                                                                                 providers & schemes.
                                     Render secretarial support to
                                     appeal board.




                                                               Council For Medical Schemes
                                                               Regulatory plan and budget
                                                                  2004/5 Financial Year
                                                                                                                                        Page 42 of 64
                                                                                                                 Part2: Regulatory Plan
                                                                                                                        Complaints Unit

Complaints unit

To monitor and effectively resolve complaints raised by members and the public.

OBJECTIVES                          ACTIVITIES                         OUTPUTS                            OUTCOME
Resolve complaints raised by        Analyse complaints raised by       Acknowledgement sent to            Informed members
beneficiaries                       beneficiaries and send to          members within 5 days of receipt
                                    schemes for responses as           of complaint
                                    required by Section 47 of the
                                    Medical Schemes Act
                                    Resolve complaints, having        50% of complaints resolved          Speedy resolution of complaints
                                    received responses from schemes   within 30 days; 90% within 60
                                                                      days and 100% within 90 days
                                    Inform complainant of outcome of Letter to complainants within 3      Improved member confidence in
                                    complaint or any further action   days of having received response    complaints resolution system
                                    where necessary                   from scheme, and taking a
                                                                      decision on complaint
Make progress in cases where        Submit a ruling for Registrar’s   Submit ruling to Registrar within   Members whose complaints are
schemes fail to respond within 30   assent in all cases where schemes 5 days of end of period provided    not responded to by schemes are
days                                have failed to respond within 30  to scheme                           able to have rulings made by the
                                    days                                                                  Registrar
                                    Inform complainant and scheme     Rulings dispatched to complainant
                                    of Registrar’s ruling             and scheme within 5 days of
                                                                      ruling

Resolve complaints through          Arrange dispute resolution         Dispute resolution meeting held
mediation                           meetings where conciliation has    within 7 days of deadlock
                                    failed or where complainant
                                    indicated dissatisfaction


                                                          Council For Medical Schemes
                                                          Regulatory plan and budget
                                                             2004/5 Financial Year
                                                                                                                                Page 43 of 64
                                                                                                                   Part2: Regulatory Plan
                                                                                                                          Complaints Unit

OBJECTIVES                          ACTIVITIES                          OUTPUTS                             OUTCOME
Handle walk-in consultations        Provide speedy assistance to        Attending to members timeously      Enhanced customer service
                                    “walk-in” complainants
Resolve complaints received from    Organise meeting between            50% resolved within 45 days,        Improved payment of claims by
service providers                   provider(s) and scheme to resolve   80% within 60 days and 100%         schemes
                                    complaint on non-payment of         within 120 days
                                    accounts
Appeals in terms of Section 48 of   Provide input to Appeal Sub-        Documentation on appeals for        Appeals are dealt with by Council
the Medical Schemes Act             Committee on behalf of the          Legal Services or Appeal            effectively
                                    Registrar as appropriate            Committees within 2 weeks of
                                                                        appeal hearing
Giving members accurate             Enhance interdepartmental           Meetings once a month to discuss    Members are well informed on
information                         communication                       new developments on the Act and     the Medical Schemes Act
                                                                        the industry as a whole
Improve awareness of                Presentations on complaints         On request by training officer      Greater awareness by the public
complaints handling and             handling processes                                                      of complaints resolution
processes by consumers, trade                                                                               mechanism within schemes
unions, and schemes and trustees

                                    Radio Talk Shows on complaints      On request by Communication         Greater awareness by the public
                                    handling                                                                of complaints resolution
                                                                                                            mechanism within schemes
Improve resolution process at       Review the draft document which     In conclusion with the Registrar,   Improved complaints resolution
scheme level                        has already been forwarded to       working document by June 2004       by schemes
                                    the Registrar for finalization




                                                          Council For Medical Schemes
                                                          Regulatory plan and budget
                                                             2004/5 Financial Year
                                                                                                                                  Page 44 of 64
                                                                                                           Part2: Regulatory Plan
                                                                                                                  Complaints Unit

OBJECTIVES                     ACTIVITIES                         OUTPUTS                           OUTCOME
Management of the Complaints   Monitor and manage the             Two sessions per year. Monthly    To enhance CMS as employer of
Unit                           performance of staff within the    meeting with every staff member   choice
                               unit
                                                                  Formal performance evaluation     A culture of feedback and
                                                                  sessions                          performance

                                                                  Expenditure within budget         Expenditure reflects activities

                                                                  Monitor adherence to budget




                                                     Council For Medical Schemes
                                                     Regulatory plan and budget
                                                        2004/5 Financial Year
                                                                                                                            Page 45 of 64
                                                                            Part2: Regulatory Plan
                                                                  Communication and Education Unit

Communication and education unit
Sub-heading

OBJECTIVES             ACTIVITIES                OUTPUTS               OUTCOME




                                    Council For Medical Schemes
                                    Regulatory plan and budget
                                       2004/5 Financial Year
                                                                                        Page 46 of 64
                                                                                                                  Part2: Regulatory Plan
                                                                                                                   Internal Finance Unit

Internal Finance Unit

OBJECTIVES                        ACTIVITIES                           OUTPUTS                             OUTCOME
Prepare accurate monthly          Accurate recording and               Submit financial information in     Management accounts are
management accounts for           processing of transactions in        the prescribed format on actual     produced monthly and serve at
Council. S40 (4) b                various books of first entry.        revenue and expenditure of the      SMM, Council and Audit
                                  Correct allocation of account        preceding month.                    Committee.
                                  codes in the processing of
                                  cheques and receipts.                Management reports e.g. Income      The structures interrogate these
                                                                       statement, Balance Sheet, Cash      accounts and provide advice
                                                                       flow statement, Variance report     where applicable.
                                                                       and notes to the financial
                                                                       statements are produced.            Decisions are taken on the basis
                                                                                                           of a fair presentation of accounts
Prepare Annual Financial          Collect all the invoices and         Annual financial statements are     To have an unqualified audit
Statements and ensure that they   receipts and any other relevant      submitted to the Auditor General    opinion each year.
are audited. (S55). Financial     information needed for the           and Treasury on 31 May each
statements are prepared in        making of provisions and             year.                               Annual financial statements are
accordance with the generally     prepayments.                                                             tabled in the National Assembly
accepted accounting practice.                                          Audit Committee evaluates the       by the Minister on 30 September
                                  Prepare an audit file                AFS seven days after the Auditor    each year.
                                                                       General report.

                                                                       Submit annual financial
                                                                       statements to relevant Treasury
                                                                       and the Executive Authority by 31
                                                                       August each year.




                                                          Council For Medical Schemes
                                                          Regulatory plan and budget
                                                             2004/5 Financial Year
                                                                                                                                  Page 47 of 64
                                                                                                                    Part2: Regulatory Plan
                                                                                                                     Internal Finance Unit

OBJECTIVES                          ACTIVITIES                            OUTPUTS                            OUTCOME
Maintenance of effective and        Conduct a risk assessment             Revised policies incorporated in   Ensure that Council transactions
efficient Internal Controls.        regularly to identify emerging risk   the finance and procedure          are conducted in terms of the
(TR.3.2), S38 (ia), S76 (4).        of Council. (Work of internal         manual.                            finance policies, HR policies and
                                    auditors).                            A revised Fraud prevention plan.   any other relevant legislation
Revision of financial policies in                                                                            governing Council e.g. Companies
line with the PFMA.                 Document the necessary changes                                           Act, Income Tax Act, UIF, SDA
                                    and discuss them at SMM.                                                 etc.

                                    Communicate the internal                                                 Maintenance of policies that is
                                    controls to all staff.                                                   consistent with changing needs of
                                                                                                             the corporate environment and
                                    Discuss with audit committee                                             relevant legislation.

                                                                                                             An improved culture of adherence
                                                                                                             to internal control is maintained in
                                                                                                             Council.

                                                                                                             A risk management strategy is
                                                                                                             produced which include
                                                                                                             -Fraud prevention plan

                                                                                                             Workshops are conducted with
                                                                                                             staff.




                                                           Council For Medical Schemes
                                                           Regulatory plan and budget
                                                              2004/5 Financial Year
                                                                                                                                     Page 48 of 64
                                                                                                              Part2: Regulatory Plan
                                                                                                               Internal Finance Unit

OBJECTIVES                         ACTIVITIES                         OUTPUTS                          OUTCOME
To ensure Audit Committee          Audit committee meetings are       Audit committee meetings take    Continuous assessment of the
meetings are held quarterly.       held quarterly.                    place as scheduled.              financial position of Council and
(TR.3.1), S76 (4d)                                                                                     the identification of risks inherent
                                   Preparation of documentation and   Audit Committee                  in the management of an
An effective and properly          distribution to Audit Committee    recommendations are              organisation. Provide financial
constituted Audit Committee in     members seven days before the      implemented timeously.           advice to Council.
terms of the PFMA.                 meetings to all audit committee
                                   members e.g. Financial
                                   Statements, policy documents
                                   etc.

                                   Communicate Audit Committee
                                   recommendations to relevant
                                   structures of Council.

                                   Review Terms of Reference of
                                   Audit Committee members
                                   annually.

                                   Review audit charter and
                                   communicate to Audit Committee
                                   members annually.
Preparation and maintenance of     Consultative budget meetings are   Reviews are documented to        The budget is approved by the
Annual Budget. (S53)               convened in line with the budget   comply with the Public Finance   Executive Authority.
                                   cycle.                             Management Act (PFMA).
Review budget to ensure                                                                                A levy on schemes is determined
consistency with approved budget   Cost centre heads submit their     A consolidated budget is         and published in the gazette
and projected cash flow.           budget inputs with clear           submitted six months before or
                                   projections on a month to month    another period agreed to.


                                                        Council For Medical Schemes
                                                        Regulatory plan and budget
                                                           2004/5 Financial Year
                                                                                                                               Page 49 of 64
                                                                                                              Part2: Regulatory Plan
                                                                                                               Internal Finance Unit

OBJECTIVES                     ACTIVITIES                           OUTPUTS                            OUTCOME
                               basis. Obtaining quotations where
                               applicable.

                               Consolidate the Council budget.

                               Monthly variance reports are
                               produced.

Revenue Management (S38)(1)    Collect all monies due to Council.   Improved debtor’s collection       An accurate presentation of
                                                                    system is maintained in Council.   Debtors balances in the balance
                               Maintain proper records of all                                          sheet.
                               debtors.
                                                                    Management of revenue is in line   Manage revenue efficiently and
                               Charge interest on overdue           with the PFMA.                     effectively.
                               accounts.

Expenditure Management (S76)   Ensure all expenditure is            Statutory creditors are settled    An accurate presentation of
(4)b                           necessary; all expenditure is        within the prescribed period.      Creditors balance in the balance
                               appropriate and is paid promptly.                                       sheet.

                               Ensure that expenditure is           Expenditure is managed and is in   Ensure there is no fruitless and
                               approved, in line with budget and    line with budget and strategic     wasteful expenditure.
                               in line with strategic objectives.   objectives.




                                                      Council For Medical Schemes
                                                      Regulatory plan and budget
                                                         2004/5 Financial Year
                                                                                                                              Page 50 of 64
                                                                                                                  Part2: Regulatory Plan
                                                                                                                   Internal Finance Unit

OBJECTIVES                        ACTIVITIES                           OUTPUTS                             OUTCOME
Procurement system (T.R. 16.6.)   Review procurement policy in the     Sign contracts and service level    A fair, open and transparent
                                  policies and procedures              agreements with preferred           procurement system that ensures
                                  document.                            suppliers.                          compliance with BEE principles is
                                                                                                           maintained.
                                  Ensure that procurement is in line   Ensure preferred supplier list is
                                  with policy.                         maintained.                         Report on BEE suppliers is
                                                                                                           provided.
Cash Management (S11)             Implementation and maintenance       Determine cash flow                 Make informed decisions on cash
                                  of an EFT system.                    requirements from time to time.     flow requirements.

                                  Adherence to investment policies.    Investments are held with
                                  Making timeous payments.             approved financial institutions.

                                  Cash forecast/cash flow
                                  projections.

                                  Bank accounts approved by
                                  Treasury.
Asset Management (S31)(1)d        Maintenance of an up to date         Proper control systems exist for    Council’s assets are not exposed
                                  fixed asset register.                assets.                             to risks.

                                  Ensure that assets are insured at
                                  all times.




                                                         Council For Medical Schemes
                                                         Regulatory plan and budget
                                                            2004/5 Financial Year
                                                                                                                                 Page 51 of 64
                                                                                                                   Part2: Regulatory Plan
                                                                                                                    Internal Finance Unit

OBJECTIVES                         ACTIVITIES                            OUTPUTS                            OUTCOME
Personnel costs management.        A payroll system that complies        Salaries are paid on the 25TH of   All salaries are within budget and
(T.R 8.3.)                         with relevant legislation is          each month.                        for appointed staff.
                                   maintained.
                                                                         Personnel costs are within
                                   Legislated deductions against         budget.
                                   payroll are made.
                                                                         Produce accurate information on
                                   Ensure that all appointments are      the IRP5 at the end of each tax
                                   approved by the CEO.                  year.

                                   Changes to conditions of
                                   employment approved by CEO.
Ensure that personnel in Finance   Develop training plans for staff in   Staff is encouraged to enrol for   Staff is up to date with
are adequately skilled.            Finance.                              courses in line with their         developments around financial
                                                                         accountabilities.                  management e.g. PFMA and
                                   Workshops are arranged for staff                                         Treasury Regulations.
                                   to equip themselves with the
                                   changing financial management                                            Staff are also able to advise on
                                   environment.                                                             financial management.

                                                                                                            Internal Finance is adequately
                                                                                                            staffed.




                                                           Council For Medical Schemes
                                                           Regulatory plan and budget
                                                              2004/5 Financial Year
                                                                                                                                   Page 52 of 64
                                                                                                                  Part2: Regulatory Plan
                                                                                                       Human Resources Development Unit

Human resources development unit
Continue the development of CMS as an employer of choice

OBJECTIVES                            ACTIVITIES                            OUTPUTS                              OUTCOME
Realign the organizational            Communicate broad aims, plans         A report every two months to the     People within the organization are
objectives and the context within     and progress of the process to        wider organization on progress       put in the center of organizational
which staff work, through by          the wider organization                being made by CMS Active             strategy which allows for
facilitating the development of                                                                                  collective thought, trust and
organizational strategy through                                                                                  commitment to developing
CMS Active.                                                                                                      direction for the Council.
Coordinate the ‘visioning’ sessions   Identify and agree specific           Agreement within CMS Active on       Staff is engaged on the HR
of CMS Active                         themes of a people strategy to        initial topic to handle, by March    direction the organization will
                                      commence with.                        2004.                                make a difference and possible
                                                                                                                 barriers to obtaining that vision.
                                      Develop proposals, through CMS        New proposals on performance         A performance driven
                                      Active, on the following issues       management to SMM, by end            organizational culture is nurtured
                                      pertaining to People processes:       April and to Council by end of       and developed.
                                      (i) Performance management, (ii)      May 2004.
                                      remuneration strategy, (iii) skills
                                      development and career pathing,
                                      and succession planning at CMS.
Develop a set of culture, values      Develop proposals, through CMS        A skills audit report and training   A culture of learning is fostered,
and core beliefs that the             Active, on the following issues       plan to SMM by July 2004.            and staff are able to identify
organization can agree on.            pertaining to Cultures and Values     Recommendations on career            career paths within the CMS.
                                      at CMS: (i) Creating a positive       pathing and succession planning
                                      environment for work motivation,      to SMM by July and to Council by
                                      (ii) teamwork, (iii) managing         August 2004.
                                      diversity and fostering a non-
                                      discriminatory environment.


                                                             Council For Medical Schemes
                                                             Regulatory plan and budget
                                                                2004/5 Financial Year
                                                                                                                                         Page 53 of 64
                                                                                                       Part2: Regulatory Plan
                                                                                            Human Resources Development Unit

OBJECTIVES                       ACTIVITIES                        OUTPUTS                             OUTCOME
                                                                   A remuneration strategy to SMM      Consistency and clarity is
                                                                   by end of September, and to         provided in remuneration and is
                                                                   Council by end of November          linked to career pathing.
                                                                   2004.

                                                                   Actions plans to create an          Optimise human capital by
                                                                   environment in which staff can be   bringing human element to the
                                                                   motivated to deliver their best     fore by motivating staff to deliver
                                                                   performance, by June 2004.          their best.

                                                                   Action plans for fostering          An environment that allows each
                                                                   successful teamwork, including      member of staff to contribute
                                                                   skills required by mangers to       optimally in his/her own unique
                                                                   promote team work, by               way.
                                                                   November 2004.
                                                                   Action plan for managing            An organization where barriers
                                                                   diversity, by February 2005.        have been dissolved while still
                                                                                                       operating within the letter and
                                                                                                       spirit of non-discrimination laws.

Forecast the demand and supply   Secure suitably qualified         Timely recruitment of talented      Improved management of
of personnel with particular     permanent and temporary staff.    personnel for both permanent        recruitment.
attention to scarce skills                                         and temporary positions through
                                                                   advertising and headhunting         Talented staff are attracted and
                                                                                                       retained.




                                                      Council For Medical Schemes
                                                      Regulatory plan and budget
                                                         2004/5 Financial Year
                                                                                                                               Page 54 of 64
                                                                                                             Part2: Regulatory Plan
                                                                                                  Human Resources Development Unit

Implement Affirmative Action and Employment Equity in line with National Policy

OBJECTIVES                           ACTIVITIES                          OUTPUTS                             OUTCOME
Manage equity profile in line with   Report on Employment Equity in      DoL informed of the                 Equity targets within the Council
National objectives.                 terms of the Employment Equity      Employment Equity status for the    developed in line with the
                                     Act                                 Council for Medical Schemes for     Employment Equity Act.
                                                                         2004/05
                                     Chair and facilitate the EE Forum   All staff informed and engaged in   Requirements of the Employment
                                                                         process of developing               Equity Act fulfilled.
                                                                         Employment Equity Plan for the
                                                                         Council.
                                     Develop an Employment Equity        EE Framework and EE Plan are        Requirements of the Employment
                                     Framework                           presented to SMM by April 2004.     Equity Act fulfilled.
                                     Develop an Employment Equity        EE plan presented to SMM by May     Requirements of the Employment
                                     Plan.                               2004and to Council by June 2004.    Equity Act fulfilled.
                                     Submit EE Plan to Dept. of Labour   Plan submitted to DoL Labour by     Requirements of the Employment
                                                                         July 2004.                          Equity Act fulfilled.




                                                            Council For Medical Schemes
                                                            Regulatory plan and budget
                                                               2004/5 Financial Year
                                                                                                                                    Page 55 of 64
                                                                                                        Part2: Regulatory Plan
                                                                                             Human Resources Development Unit

Assist managers to implement performance management

OBJECTIVES                        ACTIVITIES                        OUTPUTS                            OUTCOME
Manage Performance in line with   Assist managers to implement a    New system is implemented by       Managers are competent and
care and grow principle.          new performance management        June 2004.                         objective in their management of
                                  system.                                                              performance of staff.
                                  Collate results, managed          Results are collated, documented   Performance bonuses effected on
                                  moderation as required and        and tabled to the moderating       time in an objective formalized
                                  formalize payment of              committee for approval, by end     fashion.
                                  performance bonuses.              June and end November 2004.

                                                                    Payment of performance bonuses
                                                                    effected by 20 December 2004.




                                                       Council For Medical Schemes
                                                       Regulatory plan and budget
                                                          2004/5 Financial Year
                                                                                                                            Page 56 of 64
                                                                                                     Part2: Regulatory Plan
                                                                                          Human Resources Development Unit

Organizational Efficiency and Effectiveness

OBJECTIVES                       ACTIVITIES                        OUTPUTS                          OUTCOME
Monitor efficiency and           Provide ongoing                   Effective and efficient          Improved internal service to staff
effectiveness of organization.   Employee relations and general    management of Human Capital in
                                 consultancy to Heads, Line        the employ of the Council        Audit HR policies, and submit to
                                 Mangers and staff                                                  SMM for approval after staff
                                                                                                    consultation.




                                                      Council For Medical Schemes
                                                      Regulatory plan and budget
                                                         2004/5 Financial Year
                                                                                                                           Page 57 of 64
                                                                                                   Part2: Regulatory Plan
                                                                                        Human Resources Development Unit

Develop Management competencies (on soft issues)

OBJECTIVES                   ACTIVITIES                         OUTPUTS                        OUTCOME
Implement a Management       Conceptualize Management           Concept plan to SMM, by May    Managers acquire competencies
Development programme        Development Programme for          2004.                          in management of soft issues.
                             Council’s managers.




                                                   Council For Medical Schemes
                                                   Regulatory plan and budget
                                                      2004/5 Financial Year
                                                                                                                   Page 58 of 64
                                                                                                                   Part2: Regulatory Plan
                                                                                                             Information Technology Unit

Information technology unit

OBJECTIVES                            ACTIVITIES                         OUTPUTS                             OUTCOME
To facilitate an efficient, timely,   Investigate and prepare a Final    Detailed Technical Specification    Improved workforce efficiency
focused and educated workforce,       Technical Specification Document   and RFP Document on EDMS and        through electronic collaboration.
through information technology        and RFP Document for a robust      Knowledge Bank Prepared by end
interventions.                        Electronic Document Management     March 2005.
                                      Solution and Knowledge Bank.

                                      Deploy a Human Resource            Human Resource Management           Improved workforce efficiency
                                      Management System.                 System deployed by end July         through electronic collaboration.
                                                                         2004.
                                      Deploy a new Resource Center       Resource Center System deployed     Improved workforce efficiency
                                      Management system.                 by end July 2004.                   through electronic collaboration.
To source and maintain the latest     Reliable, stable and efficient     New Accreditation System rolled     Our stakeholders are always able
information on our stakeholders       database solutions developed and   out for use by End July 2004.       to access data pertaining to their
by implementing mechanisms to         maintained.                                                            areas of responsibility quickly,
increase the proportion of data                                          Schemes Database improved and       effectively, anytime and
available to council.                                                    consolidated by end May 2004.       anywhere.

                                                                         CMS Tracker System developed
                                                                         and deployed on an
                                                                         organizational level by end April
                                                                         2004.

                                                                         Statutory Return System deployed
                                                                         as per set schedule.

                                                                         Shadow REF Return developed,
                                                                         tested and deployed by
                                                           Council For Medical Schemes
                                                           Regulatory plan and budget
                                                              2004/5 Financial Year
                                                                                                                                    Page 59 of 64
                                                                                                                 Part2: Regulatory Plan
                                                                                                           Information Technology Unit

OBJECTIVES                         ACTIVITIES                          OUTPUTS                             OUTCOME

                                                                       November 2004.

                                                                       Web Zones for Brokers,
                                                                       Brokerages, Administrators etc.
                                                                       Deployed by end of February
                                                                       2005.

                                                                       Fully functional WAP Site
                                                                       developed by 1 April 2004.

                                   Maintain an efficient IT Helpdesk   Ongoing IT Helpdesk function        All our stakeholders (internal)
                                   by means of different               maintained at an Industry Level     ensured of an Efficient Helpdesk
                                   interventions such as network       Service Standard with adherence     function.
                                   maintenance and support etc.        to Industry Norm Response
                                                                       Times.
To facilitate an environment in    Maintain a fully interactive        Ongoing development and             Improved Web and WAP access
which external stakeholders are    website with dedicated member       maintenance of:                     to all stakeholders.
informed, empowered and            zones which are user friendly,          • Public Access Areas
educated through the application   informative and educational.            • Member Access Areas
of relevant information                                                    • WAP Site
technology.
                                   Supplement this Website with an
                                   Interactive WAP Site for Mobile
                                   users.
Ensure 100% “uptime” through       LAN infrastructure tested and       LAN cabling tested twice annually   True 100 Mbs connectivity
effective maintenance, upgrade     maintained.                         for problems and defunct cabling    maintained.
and administration of the cms                                          replaced or patched.
information technology
infrastructure.
                                                          Council For Medical Schemes
                                                          Regulatory plan and budget
                                                             2004/5 Financial Year
                                                                                                                                 Page 60 of 64
                                                                                                                    Part2: Regulatory Plan
                                                                                                              Information Technology Unit

OBJECTIVES                          ACTIVITIES                           OUTPUTS                              OUTCOME
                                    Server farm health regularly         Ensure that all servers are          All servers running at peak
                                    assessed and required “patches”      running the latest service packs     performance with 100% uptime
                                    loaded.                              and that they perform optimally      24/7.
                                                                         once a week.

                                    Telephony infrastructure tested      Perform checks on the Telephone      Telephone system running at
                                    and maintained.                      system once a week.                  peak performance with 100%
                                                                                                              uptime 24/7.
Ensure that disaster recovery and   Perform Daily Differential Backups   Backups performed on a               Data remain intact and can be
data backup procedures are in       and Weekly Full Backups.             scheduled daily and weekly basis.    recovered if lost.
place.
                                                                         Backup tapes stored offsite on a
                                                                         weekly and monthly basis.

                                                                         Backed up data restored from
                                                                         time to time to test backup
                                                                         success.

                                    Uninterrupted Power Supply           Ensure that the Power Generator      IT Infrastructure remains fully
                                    System (UPS) tested and              (Genset) and UPS remain              functional in case of major power
                                    maintained.                          optimally functional by performing   outage.
                                                                         failover tests bi-weekly.

                                    Environmental Monitoring System      Perform failover tests weekly to     Server rooms and data remain
                                    on main server room tested and       ensure that all the EMS Alarm        intact in case of fire, high
                                    maintained.                          triggers are in working condition.   temperature and humidity.




                                                          Council For Medical Schemes
                                                          Regulatory plan and budget
                                                             2004/5 Financial Year
                                                                                                                                    Page 61 of 64
                                                                                                                Part2: Regulatory Plan
                                                                                                          Information Technology Unit

OBJECTIVES                        ACTIVITIES                           OUTPUTS                            OUTCOME

Ensure that adequate domain       Security infrastructure tested and   Check Intrusion Detection Logs     Unauthorised access attempts
security measures are in place.   regularly checked for                weekly to monitor possible         (hacks) prevented and attempts
                                  vulnerabilities.                     intrusion attempts.                (hacks) monitored and reported
                                                                       Perform Controlled Intrusion       to relevant authorities.
                                                                       Attempts twice a year to test
                                                                       system vulnerability.

                                  Continue to Fine tune Group          Perform a monthly review of        End-User environment controlled
                                  Policy to enable a secure private    Group Policy Objects and fine      and restricted to ensure a secure
                                  network.                             tune if required.                  domain.
                                  Ensure the upkeep of Anti-Virus      Perform daily checks to ensure     Ensure a 100% Virus Free
                                  Measures to prohibit the spread      that the newest Anti-Virus         Domain 24/7.
                                  of computer viruses or malicious     Patterns have been disseminated
                                  Trojans or worms.                    on the domain.
To ensure that information        Establish an IT Sub-Committee.       IT Sub-Committee established by    IT Sub-Committee established.
technology policies and                                                end April 2004.
procedures are formulated and
updated.

                                  Develop a Business Continuity        Business Continuity Plan           Policies and procedures
                                  Plan which will incorporate a        developed by IT Sub-Committee      formulated and up to date.
                                  Disaster Recovery Plan.              by end of November 2004.
                                  Establish a List of Preferred        Establish a List of Preferred      A list of Preferred Suppliers in
                                  Service Providers in collaboration   Service Providers before the end   terms of various services required
                                  with Finance Unit.                   of August 2004.                    within IT established.




                                                         Council For Medical Schemes
                                                         Regulatory plan and budget
                                                            2004/5 Financial Year
                                                                                                                                 Page 62 of 64
                              Part3: Budget for 2004 / 2005




                                                 Part 3.

                                      Budget
                              For 2004 / 2005




Council For Medical Schemes
Regulatory plan and budget
   2004/5 Financial Year
                                                 Page 63 of 64
                              Part3: Budget for 2004 / 2005




Council For Medical Schemes
Regulatory plan and budget
   2004/5 Financial Year
                                                 Page 64 of 64

								
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