Guiding consumers since 2009

5 reasons the NHI amendments could be what the doctor ordered

By Athenkosi Sawutana

Changes to align medical aid schemes to the proposed National Health Insurance (NHI) were proposed on Thursday by Aaron Motsoaledi, the Minister of Health.

The announcement was received with mixed feelings, some claiming the NHI itself was unsustainable while others welcomed the changes with open arms.  

According to a press release issued by the Department of Health, here is why the changes could benefit you:

  1. You will not have to chip in for payment when you go to a doctor

The minister announced that he will abolish co-payments. Co-payment means that the scheme pays part of the bill charged by the service provider to a patient. The rest of the money is paid by you, the patient.

“The amendment means that every cent charged to the patient must be settled fully by the scheme and the patient should not be burdened with having to pay,” stated the press release.

  1. You will not be paying the middle man

According to Motsoaledi, you are unknowingly paying R90 to a broker, which resulted in more than R2 million going to brokers in 2017.

“We want this money to be made available to pay for direct health expenses of members rather than serving brokers who are actually not needed in the healthcare system,” said Motsoaledi.

  1. Your medical aid will cover all your medical needs

According to the Medical Schemes Act your medical aid is paying for 270 conditions, called Prescribed Minimum Benefits (PMB). If the condition is not on the list, the scheme asks you for a co-payment. Now with the proposed bill, the full cost of your medical bills will be covered.

“Prescribed Minimum Benefits were mostly hospital-based conditions. Comprehensive service benefits will include Primary Health Care (PHC) like family planning, vaccination, screening and wellness services,” stated the press release.

  1. The savings will go straight into your pocket.

Currently,  medical aid schemes can force you to use their designated service providers to save money. The problem is that those savings do not go into your bank account, they go into the schemes’ coffers.

 According to Motsoaledi, medical aid schemes will be compelled to pass back savings if a member uses a designated service provider according to the rules of the scheme.

  1. You will not be penalised for late joining or your age

Even though medical schemes accept people of all ages, when a person is 80 and was not previously affiliated to a medical scheme, the scheme can charge a late-joiner penalty.

“Under NHI there will be no penalty related to late joining or age. This is to protect the interest of the living spouse after the passing of the principal member or after retirement prior to payment of their benefits,” according to the press release.

To read the gazetted bill, click here.


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