New Government plan can immediately increase your medical aid fees by 15%

Medical aid premiums for everyone older than 34 in South Africa can immediately increase by 15% if the government pushes through its proposed amendments to the Medical Aid Schemes Bill.

This is the warning from stakeholders who presented their feedback about the planned amendments to the Department of Health.

Health minister Aaron Motsoaledi has presented the National Health Insurance Bill and the Medical Schemes Amendment Bill.

Motsoaledi said the bills will pave the way for more access to medical healthcare and represent a massive shake-up to both the governmental and the private healthcare systems.

Motsoaledi outlined 10 major changes the Medical Schemes Amendment Bill will make to the Medical Schemes Act.

  1. End of co-payments, which will force medical schemes to pay for the full amount charged to a patient.
  2. Abolishment of brokers, because nearly two-thirds of medical schemes clients pay R2.2 billion to brokers without their knowledge.
  3. Abolishment of Prescribed Minimum Benefits, which are set to be replaced with comprehensive service benefits.
  4. Addresses unequal benefit options, which prevents any medical scheme from implementing any benefit option.
  5. Offence for ‘fake’ medical schemes, which makes it an offence for a business to label itself as a medical scheme should it not meet the current prescribed requirements under the Act.
  6. Creation of a central beneficiary registry, which enables the Registrar of Medical Schemes to understand the trends and behaviours of consumers when they are selecting a medical scheme.
  7. Income cross-subsidisation model, which forces medical schemes to ensure that the rich help subsidise the poor.
  8. Medical aids must ‘pass back’ savings, where any cost-savings should be passed on to patients.
  9. Cancellation of membership, which removes the need to pay to receive cover after cancelling.
  10. Governance of medical aid schemes, which introduces minimum education requirements before someone is allowed to join a board of or become a CEO of a medical aid scheme.

Risk of higher premiums

Stakeholders have now warned that the proposed amendments can result in an immediate medical aid premium increase of 15% for many members.

Rapport reported that one of the biggest concerns is the limits proposed for contributions of children and young adults.

These amendments are:

  • A child beneficiary may not exceed 20% of the contribution payable in respect of an adult beneficiary.
  • A young adult beneficiary may not exceed 40% of the contribution payable in respect of an adult beneficiary.

These amendments, some stakeholders warned, can completely change the financial position of some funds.

Insight Actuaries and Consultants co-CEO Barry Childs said it can result in big increases for primary members, adult beneficiaries, pensioners, and single members.

The potential 15% increase will be over-and-above the already large increases which medical aid members face every year.

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New Government plan can immediately increase your medical aid fees by 15%