Operational Hours Mon - Fri: 8:00AM - 4:30PM
Information information@medicalschemes.co.za
+27 86 112 3267 +27 12 431 0500

Circular 15 of 2021: Revised Healthcare Utilisation Annual Statutory Return

The Council for Medical Schemes (CMS) hereby publishes the updated technical guideline document for completing the Utilisation section of the 2019/2020 Annual Statutory Return (ASR).

The implementation of the Medical Schemes Act (No. 131 of 1998) needs to be monitored to evaluate its impact on the industry and beneficiaries, and where necessary, to recommend legislative reforms. Submission of good, quality and credible data is important to achieve this objective. By reviewing data specification documents, the CMS ensures that the latest developments and best practices are incorporated for the collection of good quality data.

The following updates and changes have been made in the current technical guideline document:

Part Field Amendment
B1 to B13 (Excluding B12)
  • Co-payment by member
  • Other payment by member
Two additional fields
  • Filter
  • Number of unique beneficiaries admitted
  • Admission Type
  • Updated the filter to include all claims instead of only hospital claims
  • Number of unique beneficiaries admitted was extended to include beneficiaries treated out of hospital
  • Out of hospital category included
  • New Table
  • New part
  • Gender
  • Provider Population group
  • Longitude
  • Latitude
  • Four additional fields
  • CoMorbidity
Additional field to capture comorbidity
Updated CdRef Tables
  • CdRef 5 Managed Care Indicators
  • CdRef 10 ISHMT
  • CdRef 27 DIS (New)
  • CdRef 13 DTP


This latest version of the technical guideline document should be read in conjunction with the following updated documents.

The Healthcare Utilisation ASR system will go live on 9 March 2021 and the deadline for the submission of the 2019/2020 Healthcare Utilisation ASR will be on 14 May 2021.

Details of schemes’ Data Officers should be updated and access to the Healthcare Utilisation Annual Statutory Returns must be authorised by the  Principal Officer of the scheme, a request in this regard should be send  to Ms Busisiwe Khuzwayo (b.khuzwayo@medicalschemes.co.za).

Officials from the CMS will be at hand to address all technical queries relating to the updated Healthcare Utilisation Data specification document.

Your cooperation will be highly appreciated.

Download the Circular here.