Shock decision could exclude hundreds of thousands of\nfamilies from private medical services <\/p>\n\n\n\n
Business Live<\/p>\n\n\n\n
06 December 2019 – 05:10 Tamar Kahn <\/p>\n\n\n\n
The medical schemes regulator has sent shock waves through\nthe industry in announcing plans to scrap by March 2021 the pared-down schemes\nand primary health-care products used by low-income families.<\/p>\n\n\n\n
The move has also caught the Treasury on the back foot, with\nsources saying it was not aware of the plan.<\/p>\n\n\n\n
Without an alternative, the demise of these products could\nleave hundreds of thousands of families without access to private health care.<\/p>\n\n\n\n
The move will not only affect consumers but also throw a\nspanner in the works for medical schemes and insurers that have been developing\ncheap products aimed at low-income workers. Many of these products are\nsubsidised by employers and, at a few hundred rand a month, cost a fraction of\ntraditional medical-scheme cover.<\/p>\n\n\n\n
While the Council for Medical Schemes (CMS) said it was\ndeveloping a new and more affordable prescribed minimum benefit package with a\nstrong emphasis on primary health care, the package has yet to be costed.\nIndustry sources are sceptical that it will be in place by the 2021 deadline.<\/p>\n\n\n\n
The development is at odds with a long-standing policy aimed\nat making health insurance and medical scheme cover more affordable for\nmillions of people, said the country\u2019s biggest medical scheme administrator\nDiscovery Health.<\/p>\n\n\n\n
“It would force hundreds of thousands of families with\ncurrent primary care and related policies, providing valuable access to\naffordable health care, to be out of cover. This means that they will lose\nvaluable employer subsidies and will be forced to pay out of their own pockets\nfor private GP and other care,” said Discovery Health CEO Jonathan\nBroomberg.<\/p>\n\n\n\n
While only about 15.4 % of the population \u2014 or 8.92-million\npeople \u2014 are members of medical schemes, millions more pay for private health\ncare out of their own pockets.<\/p>\n\n\n\n
As many as 45% of households use private health-care\npractitioners, such as GPs or dentists, according to Insight Actuaries. CMS\nregistrar Sipho Kabane issued a circular on December 4, saying no low-cost\nbenefit options would be permitted going forward, and no more products based on\nexemptions to the Medical Schemes Act would be allowed after March 2021.<\/p>\n\n\n\n
Major concern<\/strong><\/p>\n\n\n\n Products caught up in this net include bargaining-council\nmedical schemes that cover workers in industries such as transport and fishing,\nwhich have for decades been allowed to provide less cover than traditional\nmedical schemes, as well as cheap primary health insurance products sold by the\nlikes of Momentum, Sanlam and Discovery Life.<\/p>\n\n\n\n The exemption framework had created opportunities for\ncompanies to offer products that were not in consumers\u2019 best interests, Kabane\nsaid. “Our major concern is that they overpromise and underdeliver,”\nhe said in an interview with Business Day on Thursday.<\/p>\n\n\n\n “The people that buy them think they are fully fledged\nmedical scheme products. They think they have comprehensive cover, and only\ndiscover at the time of access [to care] that they do not.” He said\nallowing products with different levels of cover to continue was at odds with\nthe government\u2019s plans for National Health Insurance (NHI), or universal health\ncoverage.<\/p>\n\n\n\n “The NHI talks about a comprehensive benefit package.\nIf we allow the market to be flooded with packages that have no intention of\nbeing comprehensive, it will make the transition period very difficult.”\nBoard of Healthcare Funders (BHF) MD Katlego Mothudi said that the organisation\nwas “deeply concerned” about the circular, and was subjecting it to a\ntechnical review to fully understand its implications.<\/p>\n\n\n\n The BHF is an industry association for medical schemes and\nadministrators.<\/p>\n","protected":false},"excerpt":{"rendered":" Shock decision could exclude hundreds of thousands of families from private medical services Business Live 06 December 2019 – 05:10 Tamar Kahn The medical schemes regulator has sent shock waves through the industry in announcing plans to scrap by March 2021 the pared-down schemes and[…]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/www.doctorsaid.co.za\/index.php?rest_route=\/wp\/v2\/posts\/4094"}],"collection":[{"href":"https:\/\/www.doctorsaid.co.za\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.doctorsaid.co.za\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.doctorsaid.co.za\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.doctorsaid.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4094"}],"version-history":[{"count":1,"href":"https:\/\/www.doctorsaid.co.za\/index.php?rest_route=\/wp\/v2\/posts\/4094\/revisions"}],"predecessor-version":[{"id":4095,"href":"https:\/\/www.doctorsaid.co.za\/index.php?rest_route=\/wp\/v2\/posts\/4094\/revisions\/4095"}],"wp:attachment":[{"href":"https:\/\/www.doctorsaid.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4094"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.doctorsaid.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4094"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.doctorsaid.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4094"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}