In June 2018, Aaron Motsoaledi, South African Health Minister addressed some changes that are going to be seen in the coming year with regards to medical aid schemes in the country.
He presented the new National Health Bill as well as the Medical Aid Schemes Amendment Bill, both of which are said to improve access to health care for all citizens and reduce financial distress caused by health care costs.
Motsoaledi addressed 10 major changes that are going to affect medical aid schemes in the near future. These are the changes we can expect:
#1. No More Co-Payments
This change has just about every South African doing the Madiba Shuffle! Medical aids are going to have to pay claims in full, so patients won’t have any co-payments.
Since data shows that medical schemes are withholding almost R60 billion in reserve, when they are legally only required to hold R45 billion, this change will not affect the medical sector as much as people think it might.
#2. Goodbye to Brokers
This new Bill is set to abolish the role that brokers play in the medical aid scheme space. Statistics have shown that two-thirds of clients are paying their broker's whopping sums of money each year, without their knowledge. R2.2 billion to be exact.
Besides, over the past 15 years, the number of new clients signing up for medical aid has been static, which has brought into question how necessary brokers are in this sector.
#3. No Prescribed Minimum Benefits
With the abolishment of PMBs, medical schemes are going to have to implement comprehensive service benefits. These will include services that are not often paid for under the current medical aid system and include vaccinations, family planning, and screening services.
#4. No More Unequal Benefit Options
The amendment will ensure that medical aids will no longer be allowed to implement benefit options that have not been approved by the Council of Medical Schemes Registrar. The registrar will be responsible for determining if the benefit has the member’s best interest as a priority.
#5. ‘Fake’ Medical Schemes to Face Criminal Charges
Any businesses offering health and cash plans that may look like medial schemes, or label themselves as a medical aid provider will face the law. Since the fifth amendment states that these types of companies are not registered properly through the correct channels and will not be allowed to operate.
#6. Central Beneficiary Registry
The creation of this beneficiary will give the Registrar of Medical Schemes the opportunity to understand the behaviors and trends of consumers better when choosing a scheme. Demographics like age, geographical location and disease will be used to assist the new National Health Insurance better.
#7. The Income Cross-Subsidisation Model
In basic terms, this means that the rich will help to subsidize health care for the poor, the young for the old and the healthy for the sick with the new NHI system. At the moment the opposite is true in the medical scheme space since all income brackets are charged the same tariffs for their medical cover.
#8. Patients to Benefit from Cost Savings
Most medical aids encourage patients to make use of certain service providers in an attempt to save money. However, in these circumstances, the medical scheme usually benefits from the savings and not the patient. In the future, patients will benefit from these savings.
#9. Penalties and Waiting Periods
Many schemes implement a waiting period for patients after joining the scheme before they can receive benefits. Additionally, in some cases, patients have had to pay after canceling their membership for a certain period of time. This will be abolished under the new Act as well as penalties incurred by patients that opt to join a medical aid later on in life.
#10. New Governance
The new amendment will require that medical scheme CEOs and members of the board will need minimum educational requirements to ensure proper governance within the scheme.
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