Big medical aid changes are coming sooner than you think
The Council for Medical Schemes has announced plans to review the prescribed minimum benefits (PMBs) offered to policy holders, in order to bring it in line with the upcoming National Health Insurance (NHI) legislation.
The Medical Schemes Act currently states that 270 Prescribed Minimum Benefits must be provided to all members at cost, establishing a basic standard of care to all policy holders.
One of the concerns surrounding this prescription is that it prohibits low-income persons from accessing medical aids due to its affordability.
National Treasury recently introduced two controversial regulations aimed as easing in NHI policies, including a limit on the amount of gap cover and hospital cash-back policies members can claim, as well as discontinuing all primary healthcare policies.
The move has been met with mixed reactions: in theory, healthcare will become increasingly affordable in South Africa – but at the cost of the overall level of care, which will see a legislated decrease.
The Council for Medical Schemes announced that two technical committees have been established to oversee the process of reviewing PMBs.
The Clinical Advisory Committee will define what will constitute the new PMB service package, while a Costing Committee will introduce new tariffs for this prescribed benefits package.
In full, the review process will:
- Consider, from all relevant stakeholders, the conceptual, regulatory and operational challenges related to the current PMBs.
- Consider the basket of primary healthcare and hospital-level services.
- Specify a comprehensive set of out-of-hospital an in-hospital essential healthcare benefits.
- Identify specific interventions so that the specified healthcare benefits can be provided on a sustainable basis.
- Identify measures to ensure that the specified healthcare benefits are affordable.
The process is expected to be completed by the end of February 2017 with the first changes being introduced as early as 31 March 2017.
Read: Two massive medical aid changes coming in 2017 that you need to know about
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