1. International financial reporting standard (IFRS)
What is IFRS?
How does it effect the medical schemes?
Issues arising out 2005 and 2006 Annual Financial Statement reporting
Matters for attention in 2007 year.
The BHF Southern African Conference July’07 Sun City

2. What is IFRS?
Statements issued by the International Accounting Standards Board
South African Accounting Standards follow the IFRS framework
Certain organisations are obliged to report ito IFRS.
Auditors are required to report if auditees have complied with the IFRS statements in their annual financial statements
The BHF Southern African Conference July’07 Sun City

3. What is IFRS? IFRS comprises 8 standards at this stage and is growing.
Reports are expected to be presented ito the statements from effective dates.
IFRS4 for example is being introduced in phases. First phase applied from 2005.
There are 16 International Accounting Standards which also have to be complied with covering different aspects of accounting and business transactions.
The BHF Southern African Conference July’07 Sun City

4. How does this effect medical Schemes?
Act requires that annual financial statements are prepared in terms of generally accepted accounting practices.
These practices include IAS and IFRS statements of accounting
Bill has been drafted to require medical schemes to report in terms of International Financial Reporting Standards which therefore includes IAS and IFRS statements.
The BHF Southern African Conference July’07 Sun City

5. How does this effect medical Schemes?
Prior to 2004 annual financial statements were prepared in terms of South African Standards of GAAP
2005 and 2006 were prepared ito IFRS and IAS statements
The bill, if enacted as drafted, will require schemes to continue reporting ito IFRS and IAS.
The BHF Southern African Conference July’07 Sun City

6. Issues arising out of 2005 and 2006 reporting
Medical schemes are classified as insurance businesses and must report ito IFRS4 which applies to insurance business.
Each contract between a member and the scheme is classified as an insurance contract.
Each provider contract (eg capitation) in which risk is transferred from the scheme to the provider is classified as re-insurance.
The BHF Southern African Conference July’07 Sun City

7. How does this effect medical Schemes?
There are 2 types of managed care costs:
Ones in which providers are paid for services rendered to beneficiaries
Ones in which the managed care organisation provides a service aimed at managing the provision of services such as pre-authorisation and case management.
The first is treated as a claims cost
The second could be treated as a cost of managing claims or as administration costs.
The BHF Southern African Conference July’07 Sun City

8. How does this effect medical Schemes?
Capitation fees and arrangements where risk is transferred to a provider group does not remove the ultimate responsibility for the provision of care from the scheme.
If the provider is unable to provide contracted services then the scheme will have to pay another provider for providing the same services.
The BHF Southern African Conference July’07 Sun City

9. How does this effect medical Schemes?
SAICA and CMS have jointly prepared an accounting guide to assist the schemes in preparing their AFS.
In 2005 a sample set of accounts was included in the guide
SAICA may not ito their arrangements with the International Accounting Standards Board interpret the IFRS statements.
Guideline for 2006 therefore did not include a sample set of accounts.
The BHF Southern African Conference July’07 Sun City

10. How does this effect medical Schemes?
Schemes required to interpret the IFRS themselves.
Administrators requested assistance from scheme auditors in interpretation
Different auditors had different approaches
Resulted in a variety of Income statements, in particular, being presented to members.
CMS rejected AFS of many schemes as their interpretation differed from that of the schemes
The BHF Southern African Conference July’07 Sun City

11. Issues arising from2005 AFS reporting
Accounting policies. Use relevant only.
Offsetting of fees paid to asset managers against investment income not allowed.
Materiality of expenses - disclosure
Interest paid on savings to be disclosed separately. Not deducted from investment income
Treatment of realised and unrealised profits and losses on investments
The BHF Southern African Conference July’07 Sun City

12. Issues arising from2005 AFS reporting
Correlation between the Balance Sheet, Income Statement, Cash Flow and the notes at line item level
Wash sale transactions
Risk management report
Related party transactions with particular emphasis on trustees
The BHF Southern African Conference July’07 Sun City

13. Issues arising 2006 AFS reporting
Alternate adopted by some schemes as rejected by the CMS (alternate 1)
Risk measurement in the income statement.
Gross contributions
Savings contributions
Net contributions received
Expense incurred in transferring risk to a providers. Capitation agreements.
Contribution for risk carried by the scheme
The BHF Southern African Conference July’07 Sun City

14. Issues arising 2006 AFS reporting
Claims expenses (alternate1 )
Gross claims incurred
Less paid by savings account members
Net claims
IBNR adjustment ( prior year and current year)
Plus recovery under risk transfer arrangements
Claims incurred by the scheme for own risk
Less recovery under risk transfer arrangements
Managed care management services (costs incurred in managing claims)
Claims expense
The BHF Southern African Conference July’07 Sun City

15. Issues arising 2006 AFS reporting
Alternate 2 adopted by some schemes accepted by the CMS
Gross contributions
Less savings portion
Net contributions
Claims Expense
Gross claims incurred
Less paid by savings account members
Net claims
IBNR adjustment ( prior year and current year)
Plus recovery under risk transfer arrangements
Claims incurred by the scheme
The BHF Southern African Conference July’07 Sun City

16. Issues arising 2006 AFS reporting
Risk Transfer Arrangements
Payments made to providers under risk transfer arrangements
Less: Recovery under risk transfer arrangements
Net effect of Risk Transfer Arrangements
Administration
Managed care costs management services
The BHF Southern African Conference July’07 Sun City

17. Issues arising 2006 AFS reporting
Trustees as Related parties.
Trustees are related parties
Trustee report required to reflect by trustee -remuneration paid to the trustee and expenses incurred on his/her behalf in fulfilling duties as trustees
AFS reflect the same in total and not by trustee
AFS also to include aggregate membership contributions received from trustee for himself and dependents plus any family member who is a member of the scheme in their own right
as well as aggregate benefit payments made by the scheme on trustee families’ behalf.
The BHF Southern African Conference July’07 Sun City

18. Matters for attention in 2007 year
SAICA and CMS to prepare a guideline for 2007 year.
Need to prepare guideline which reflects alternate approaches to the interpretation of IFRS which are acceptable to Schemes, Scheme Auditors and CMS.
Guideline to take into account the new IFRS7
Increased disclosure around financial instrument IAS32 and insurance risk IFRS4.
Financial managers and auditors to meet and discuss the implications so as to reduce pressure at year end.
The BHF Southern African Conference July’07 Sun City

19. IFRS
QUESTIONS
The BHF Southern African Conference July’07 Sun City