The Council for Medical Schemes (CMS) has flagged co-payments as an ‘undesirable practice’ and plans to introduce regulations in the coming months to curb the practice.<\/p>\n
Under current CMS regulations, South Africans may need to pay more for a particular treatment or medicine if it falls outside of the plan coverage on a given medical scheme.<\/p>\n
This is known as a co-payment, which is the amount that you must pay from your own pocket for a particular treatment or procedure as determined by your medical aid scheme.<\/p>\n
Medical members are often also asked to pay co-payments if they opt to visit a specialist or hospital if they have not been selected as a ‘dedicated service provider’ (DSP). This is commonly referred to as paying ‘out-of-network’.<\/p>\n
In a government gazette published at the end of April, the CMS said that this system is problematic as schemes are able to unilaterally – without restriction – determine the criteria to apply when selecting their DSPs.<\/p>\n
This unfairly limits the number of selected service providers, including pharmacies, available to provide healthcare services to the members.<\/p>\n
Members are also effectively forced to use only the selected limited number of DSPs or risk paying exorbitant co-payments.<\/p>\n
To address these and other co-payment related issues, the CMS said that it will publish new guidelines on co-payments within the next 180 days.<\/p>\n