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Here the changes that will be made to Medical Schemes Act

Minister of Health Dr Aaron Motsoaledi has announced the amendments that will be made to the Medical Schemes Act File picture: Jacques Naude

Minister of Health Dr Aaron Motsoaledi has announced the amendments that will be made to the Medical Schemes Act File picture: Jacques Naude

Published Jun 22, 2018


DURBAN - The new National Health Insurance Bill and the Medical Schemes Amendment Bill were introduced this week, but how will they affect the medical aid sector.

The amendments that have been added are meant to give patients that have financial problems due to the prices of healthcare, relief.

According to the Minister, Medical aid schemes are keeping in reserve R60 billion that is not being made use of. 

Motsoaledi added that around two-thirds of medical schemes pay R2,2 billion to brokers without their knowledge. 

The Medical Schemes Amendment Bill that was introduced by the Health Minister highlighting the changes that it will make to the Medical Schemes Act. 

Here are the changes:

1.  No more co-payments

The first amendment talks about the elimination of co-payments. This means that medical schemes will have to pay the full amount charged to a patient.

Motsoaledi said that this amendment was well thought out and the amount of complaints that the department of health and the council of medical schemes received, justifies the amendment. 

2. Goodbye brokers

The amendment bill removes the role of brokers because close to two-thirds of medical scheme clients pay R2,2 billion to brokers without them having any of knowledge of it. 

The Minister questioned the role of medical schemes because medical schemes have been stagnant. 

3. Take away Prescribed Minimum Benefits

This amendment is the elimination of Prescribed Minimum Benefits (PMBS). PMBs will be replaced by comprehensive service benefits. Motsoaledi said that the new benefits will include services like family planning and screen services. These services are not generally paid for by schemes under the present system

4. Unequal benefit options

The fourth amendment stops any medical scheme from introducing any benefit option without approval from the Registrar of the Council of Medical Schemes. This will decide whether the benefit is in the best interest of the member rather than any other party. 

5. Offence for false medical schemes

This amendment makes it an offence for a company to call itself a medical scheme if it has not met the necessary requirements under the Act. 

According to Motsoaledi, this is in relation to all the health and cash plans that are in the media to sell products that are similar to medical schemes but are not registered with the right authorities.

6. Establishing a central beneficiary registry

This will allow the Registrar of Medical Schemes to understand the trends and behaviour of consumers when they are choosing a medical scheme. 

This will include things like age and disease but excludes the consumer's personal information. 

7. Income cross-subsidisation model

Keeping with the NHI, the Minister said that medical schemes must make sure that the rich subsidise the poor, the young must subsidise the old and the healthy must subsidise the sick. 

8. No profit for medical schemes

Medical schemes should not profit so any savings should be given to patients. Medical schemes require members to visit designated service providers to save money. 

The savings are then taken by the scheme or administrator instead of being given to the members as premium reduction said Motsoaledi. 

9. Membership cancelled

This amendment says that penalties for joining a scheme late in life will no longer be allowed. Also, members would have to pay for a period before they were allowed to benefit, however, this is problematic said Motsoaledi because members would still be paying even after they cancelled their membership.

10.  Medical schemes governance

This amendment means that are minimum education requirements before a person can take an executive position in a medical aid scheme. 

NHI and medical schemes

According to the Department of the NHI is a financing system that will ensure that all citizens of South Africa (and legal long-term residents) are provided with proper healthcare, regardless of their employment status and ability to make a direct monetary contribution to the NHI Fund.

According to Motsoaledi, people that are covered by the medical aid schemes will still have to pay towards the NHI's fund. The bill makes it compulsory for all South Africans that can afford to pay towards the fund contribute to the NHI fund. 

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