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Mediclinic News : Council for Medical Schemes must put the consumer first


Council for Medical Schemes must put the consumer first




News Description

TIMES LIVE The council for Medical Schemes is to review the prescribed minimum benefits that private medical schemes must pay. That the council is doing this should prompt all medical aid members to sit up and take notice because it has ramifications for both their cover and their pocket. Prescribed minimum benefits are benefits that all medical scheme members have access to, ensuring that they have access to certain minimum health services, regardless of the benefit option they have selected. According to the Medical Schemes Act, medical schemes have to cover the full costs related to the diagnosis, treatment and care of any emergency medical condition, a limited set of 270 medical conditions and 25 chronic conditions. The review is intended to ensure that these basic benefits are "financially sustainable" and "viable". Providing cover for these benefits is one of the reasons premiums are increasing, according to the schemes. The schemes, in the absence of a cap on what the doctor or hospital can charge, have to cover the treatment no matter what the cost. If the review results in the number of prescribed minimum benefits covered being reduced, or the amount payable for a particular treatment being capped, premiums would theoretically come down. Whether that saving would be passed on to medical aid members is debatable. But if the cover is reduced scheme members could find themselves running out of cover halfway through the year. It is laudable that the council is trying to rein in costs but this should be done to the benefit of the consumer. The council's review is in line with national health policy and the proposal for national health insurance. But it should not merely rubber-stamp the NHI planning. Those handling the review need to be mindful that the NHI is nowhere near being able to provide adequate health cover for all South Africans.
Created at 2016/12/20 03:16 PM by Mediclinic
Last modified at 2016/12/20 03:16 PM by Mediclinic