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Mediclinic News : Medical benefits under review

Title

Medical benefits under review

Date

2016-12-06

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News Description

TIMES LIVE Medical aid consumers are facing premium increases of 10 percent or more next year, but the medical aid regulator may be finally doing something about rising costs. The Council for Medical Schemes announced last week that it is reviewing the Prescribed Minimum Benefits (PMBs) - the basic package of care consumers get when joining a medical aid. These benefits must be covered no matter their cost, according to the Medical Schemes Act. But most medical aids have said it is the law that pushes up premiums. The benefits mean that medical aids must cover 26 chronic conditions and 270 diseases, ensuring consumers have a basic level of care in exchange for a premium. But many schemes have provided evidence to the Competition Commission’s independent inquiry into health costs, showing the benefits are increasing costs and repelling new members. Mariné Erasmus, a health economist at Econex, said the Prescribed Minimum Benefits are accepted by the industry to be driving up costs." The council said its review needed to ensure that the basic benefits were “financially sustainable” and “viable”. It costs about R600 for a medical aid member to pay for these benefits, meaning all medical aids have to cost more than this. Older people who use these benefits cost medical aids more than R1 000 per member in a month, according to the council’s latest annual report. Erasmus said that if there is a proper review, it could work towards decreasing prices. The review will also look at what diseases are covered as a basic package of care and if some needed to be removed or added. This means the review could also be bad news for consumers as it could remove certain benefits. Medical lawyer, Neil Kirby, said if the focus of the review is on primary or preventative care, as the council’s review document suggests, it could result in fewer benefits for consumers. Healthman consultant, Johann Serfontein, said: the council’s motivation for the Prescribed Minimum Benefit review doesn’t make sense. He said they want to align medical aid benefits to the National Health Insurance scheme which is being implemented in 10 years’ time, where medical schemes will only provide supplementary cover. Discovery Health chief executive, Jonathan Broomberg, said the process outlined by the council for medical schemes appears to be carefully designed and rigorous and Discovery Health looks forward to working closely with the council to support this review.
Created at 2016/12/20 01:56 PM by Mediclinic
Last modified at 2016/12/20 01:56 PM by Mediclinic