Motsoaledi announces drastic changes to medical aid rules

21 June 2018 - 14:28 By Katharine Child
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Health Minister Aaron Motsoaledi.
Health Minister Aaron Motsoaledi.
Image: Gallo Images / Nardus Engelbrecht

There will be no more co-payments for medical aid members when medical aids don’t cover their full doctor or hospital bills if the proposed Medical Schemes Amendment Act is passed.

This is one of a raft of new changes announced on Thursday - and will severely impact on what medical aid schemes must pay for‚ and how much they must pay. The changes will also‚ however‚ affect how much you could pay for your medical aid.

Vaccinations‚ primary and preventative care and contraceptives have to be paid for by medical aids - which generally don’t cover preventative health care.

Health Minister Aaron Motsoaledi‚ speaking in Pretoria‚ has released details of the Medical Schemes Amendment Bill‚ which aims to completely change the way medical aids work.

The bill is not yet law and will be gazetted at 1pm on Friday. Thereafter‚ it will be open for public comment for three months.

The bill proposes abolishing co-payments which consumers pay if their specialist‚ hospital‚ physiotherapist or dentist charges more than their medical aid will cover. He said medical aid reserves‚ which equal 25% of their current value‚ must be used to pay for medical bills.

He criticised how much money was in medical aid reserves‚ but admitted it was a statutory requirement that medical aids keep this money in savings. The money amounts to tens of billions of rand.

Another amendment proposed in the bill is that medical aid brokers “must be abolished”‚ said Motsoaledi.

He said: “Are brokers really necessary? Almost two-thirds of people paying a medical aid premium pay a monthly sum to a broker . Many members do not even know they are paying this money every month‚ which by now about R90 per month for each member.

“The amount spent by medical aid members on brokers is R2.2-billion rand. It must be available to serve medical members as brokers are not needed in the health system.”

He will also stop hospital plans - such as those that are often on TV advertising R200 and R300 medical aid schemes - which are‚ in actuality‚ insurance policies‚ and not medical aids. Many only pay consumers money for their third day spent in hospital‚ leaving clients with huge bills.

Motsoaledi also wants medical aid premiums to cost more if you are richer and less if you earn less.

He added that the “rich must subsidise [the] sick”‚ and pay more money towards medical aids. This will be based on what they earn. A lower income earner must pay a lower contribution for the same medical aid.

“The whole point of income tax is that you pay according to your means‚” he said.

Currently‚ the price paid for a medical aid is set by the type of benefits offered and are not related to the member’s salary.

There will also be no waiting period before joining a new medical scheme as is currently the case.

Trustees of medical aids must have proper educational and financial qualifications‚ he said‚ as there are no current requirements for someone to be a trustee. 

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