On May 15, 2024, South African President Cyril Ramaphosa signed into law the National Health Insurance (NHI) Bill, marking a significant milestone in the country’s efforts to provide equitable healthcare for all citizens. The NHI Bill, a landmark piece of legislation, aims to transform the healthcare landscape in South Africa. There are multiple concerns including the quality of the legislation, the constitutionality of the Bill and the processes followed during the adoption of the Bill. The market seems to estimate that the signing of the NHI Bill is an “industry-specific risk” (pricing in of higher policy uncertainty regarding the longevity of private medical schemes in South Africa) and not a risk for the entire economy. Key Features of the NHI Bill
Implementation and Funding The implementation of the NHI will be phased over several years to ensure a smooth transition. The first phase will focus on strengthening the existing public healthcare system and expanding access to primary healthcare services. Subsequent phases will involve the gradual integration of private healthcare providers and the establishment of the NHI Fund. Reactions and Challenges The NHI Bill has garnered mixed reactions from various stakeholders. Proponents argue that it is a crucial step towards achieving social justice and improving public health outcomes. They emphasize that the NHI will help reduce health disparities and provide financial protection against the high costs of medical care. However, critics have raised concerns about the feasibility of the NHI, particularly regarding its funding and implementation. Some fear that the transition to a single-payer system could be fraught with administrative challenges and inefficiencies. There are also concerns about the potential impact on the private healthcare sector and the quality of care during the transition period. Will it affect your medica aid? Adrian Gore the Group Executive of Discovery explains very well the impact of NHI to the medical aid industry. "People are concerned about the continuity of their cover in its current form. We understand this concern. It is based on a component of the Act - Section 33 - which is problematic. Section 33 states that once NHI is ‘fully implemented’ medical schemes will be able to cover only those services that are not covered by NHI. This implies that medical scheme cover will be replaced by the NHI at that point in time. While this appears threatening, practically it isn’t. This, for two reasons. First, the impact of Section 33 is that only once the NHI is ‘fully implemented’ will medical schemes be limited in the cover they provide to medical scheme members. Until this point, there will be no change to your medical scheme cover. We believe it will take a long time – a decade at least – to achieve ‘full implementation’ given the scale and complexity of reforms needed. Bear in mind the NHI is an inordinately large and complex initiative that proposes extraordinary change and restructure to public and private healthcare systems. This is unprecedented and will be incredibly difficult to achieve. Second, even when the NHI is ‘fully implemented’, medical schemes will still be able to provide cover for benefits not covered by the NHI. This is important because the NHI is unlikely to have sufficient funding to provide an extensive package of benefits. This is because our country unfortunately faces significant financial constraints linked to low economic growth and a very narrow tax base. Medical schemes will therefore still play a significant role post full implementation of the NHI." In summary, your medical aid benefits will continue to exist, but there may be changes in how they operate alongside the NHI. It is essential to stay informed about updates from both your medical scheme provider and the NHI developments to understand how these changes might affect your coverage. The signing of the NHI Bill represents a bold and ambitious move towards transforming South Africa's healthcare system. While significant challenges lie ahead, The successful implementation of the NHI will require concerted efforts from all sectors of society, including the government, healthcare providers, and the public, to ensure that the vision of universal health coverage becomes a reality.
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In South Africa, providing adequate healthcare benefits for employees is crucial for small businesses to attract and retain talent. With numerous medical aid options available, selecting the right one can be overwhelming. However, by considering key factors and understanding the needs of your employees, you can make an informed decision that benefits both your business and your staff. How Medical Aid Affects Employee Satisfaction: Employee satisfaction often hinges on the benefits extended by an employer, with medical aid typically ranking among the most crucial offerings. A robust medical aid package not only demonstrates the employer's commitment to their staff's well-being but also fosters a sense of value and support, thereby enhancing job satisfaction. Moreover, such comprehensive medical aid plans provide employees with a sense of security, knowing that they and their families are safeguarded in times of illness or emergencies. This assurance alleviates concerns about healthcare expenses, allowing employees to concentrate fully on their work. Consequently, a workforce free from the burden of healthcare costs tends to be more focused, productive, and engaged, ultimately contributing to a motivated and high-performing team. The Role of Medical Aid in Employee Retention: Research indicates that employees are more inclined to stay with employers that provide comprehensive healthcare benefits. Retaining experienced staff not only mitigates the need for frequent recruitment, thus saving on associated costs, but also fosters a more stable and productive work environment. Here is a comprehensive guide to help you navigate the process of choosing medical aid for your small business in South Africa.
If you need advice and guidance and choosing an option for your workforce, please contact Lebogang in our Health department, email Service@daberistic.com, Tel 011-658 1333, option 2 for Medical Aid. Taking control of your medical expenses has become increasingly vital as healthcare costs continue to climb. Finding the right healthcare cover, one that is affordable and aligns with your healthcare needs, is the initial step. We offer insights into how you can save on healthcare costs by leveraging networks, Designated Service Providers (DSPs), opting for virtual care, and choosing generics to maximise your benefits. Utilising Networks One effective method to reduce monthly medical aid contributions without compromising care is opting for a network plan. Generally 15% to 20% cheaper, these plans require members to use network hospitals. Networks negotiate favorable tariffs to minimise out-of-pocket expenses and enhance value. If you choose a network plan, ensure there are doctors and facilities in your area. Be aware of co-payments for not using a DSP or network, but note that network options are waived for emergencies. Co-payments Practitioners and hospitals often charge above medical aid rates, resulting in co-payments, the portion for which you're responsible. These vary among schemes. Tariffs and Payment Rates Each scheme has a rate of payment for services rendered. Understanding this is crucial to avoid surprises. Notably, 100% of the scheme tariff doesn't necessarily cover the entire bill. Virtual Care Technology-driven innovations like virtual integration offer convenient healthcare access while minimising monthly contribution costs. Designated Service Providers (DSPs) By using DSPs, you limit out-of-pocket expenses, co-payments, and maximise annual benefits. Generic Medicines Generics offer cost-effective alternatives to brand-name drugs, often 30% to 80% cheaper, with equivalent efficacy and safety. Benefits Plan benefits vary, so read the fine print to understand coverage. Gap Cover This insurance policy covers the difference between what the medical scheme pays and the provider charges for treatments. Medical Savings Schemes allocate an annual fixed amount for medical savings. Ensure this suits your needs. Managed Care Addressing lifestyle diseases, Managed Care programs help manage chronic conditions like cancer, diabetes, and mental health. By utilising supplementary benefits smartly, you can save significantly on day-to-day expenses such as medication and screenings. Maximise your medical aid benefits wisely to access quality healthcare and extend your coverage effectively. On the 26th of September, Discovery announced its Discovery Health update for 2024. Below are the highlights: 1. Transforming members’ healthcare experience with the new Discovery Health app Your gateway to a personalised, end-to- end healthcare journey. Conveniently access care and manage your health and health plan benefits in a single app. The new app also enables new benefits for all members of Discovery Health Medical Scheme including Virtual Urgent Care, Virtual Physical Therapy, the Mental Health Assessment Benefit and digital therapeutics for mental health. You can already download the app from the App Store and Google Play. 2. Balancing affordability, sustainability and value for members in 2024 and beyond Increases to contributions for 2024 will be plan specific and will range from 0% to 12.9%, to maintain contributions in line with expected claims experience, while supporting affordability for members. Targeted plan and benefit updates for the Comprehensive series and KeyCare series ensures long-term sustainability of the benefits offered by these plans. The Comprehensive series currently has five plans. It will be consolidated into two options in 2024: Classic Comprehensive and Classic Smart Comprehensive. 3. Creating personal health pathways for all members In 2024, all Discovery Health Medical Scheme members will have access to a personal health pathway that predicts the most important actions they can take to improve their health. Members are encouraged to complete actions through an intelligent, gamified experience, which has been personalised for every adult member on the Scheme. 4. Expanding access to healthcare cover with Flexicare Flexicare is a health insurance product designed to provide a wide range of day-to-day healthcare benefits with optional add-ons, such as such as unlimited GP consultations, medicine, dentistry, optometry and so much more. Flexicare will be enhancing its primary healthcare offering in 2024 to include a nurse-led clinic pathway that provides increased access to quality primary healthcare at an affordable price point. The 2024 Discovey Health contribution table is as follows: The most affordable medical aid plan independent of income is Essential Dynamic Smart, R1,565 per month.
The most expensive plan, which provides the most comprehensive benefits, is the Executive Plan, which costs R10,303 per month. If you want to get or review the medical aid for your employees, please call our Health Department on 011-658-1333 or email service@daberistic.com. All the large open medical schemes in South Africa have announced their contribution increases for 2024. Below is the list. Discovery Health says the average weighted increase across DHMS plans is 7.5% for 2024. Excluding the Medical Savings Accounts, the increase on Risk Contributions is 10.5%.
If you want to review your medical aid plan, please call our Health Department on 011-658-1333, Option 2 or email service@daberistic.com. Medical aid members should prepare for substantial premium increases from Discovery, Momentum, and Bonitas in January due to inflation and other costs. Discovery Health Medical Scheme will see an average 7.5% increase in premiums, with about 27% of members facing hikes exceeding 10%. The Executive and Coastal Core plans will experience the most significant increases at 12.9%, while the Classic Saver plan will rise by 3%. Momentum Medical Scheme anticipates a 9.6% weighted average premium increase for 2024, and Bonitas Medical Fund plans a 6.9% increase across its nine plans. Damian McHugh, Chief Marketing Officer of Momentum Health Solutions, mentioned rising claims costs and inflation driving up average claim expenses. Dr. Ryan Noach, CEO of Discovery Health, highlighted Covid-19 costs, which totaled R700 million last year, and the impact of high interest rate hikes on members. Bonitas observed a 25% increase in mental health hospital admissions, especially in the 18 to 44 age group, attributed to economic burdens and psycho-social challenges. Profmed Medical Scheme's CEO, Craig Comrie, stressed the challenge of healthcare inflation, driven by advanced medical technologies and the rising prevalence of diseases. He also noted potential cost increases to R2,600 per member per month within a decade, surpassing salary inflation. Rising claims costs are influenced by factors like medical technologies and lifestyle-related health conditions. Changing demographics, an aging population, and increased health conditions contribute to the cost burden. Younger members joining medical schemes later in life due to rising unemployment disrupt the traditional cross-subsidization model. This challenge is unique to South Africa and requires healthcare reform. The issue of rising healthcare costs is not unique to South Africa and presents a global challenge, driven by longer life expectancies and the need for extensive healthcare services. In South Africa, Medical Aid normally means private Medical Aid. The following are the general process for hospitalisation in South Africa: 1. Purchase Medical Aid: First, you need to purchase an appropriate Medical Aid plan, which is usually a contract with a private Medical Aid company such as Discovery, Momentum, Bonitas, etc. Different plans offer different cover and benefits. 2. Hospital Admission: If you require hospitalization, you need to register at the hospital's front desk or reception desk. You will need to provide your Medical Aid information, such as your Medical aid membership number, as well as personally identifiable information. 3. Authorization and Approval: In all cases, the Medical Aid company needs to approve your hospitalization before the procedure or treatment begins to ensure that it is covered. The contact number for Discovery Medical Aid is 0860-99-88-77 Momentum Medical Aid is 0860 117 859 Bonitas Medical Aid is 0860 002 108 Insurance companies also provide WhatsApp customer service You should obtain an authorization number, known as an authorization number in English, and provide it to the hospital and doctor. In the case of emergency, hospitals would contact your Medical Aid provider and request authorization, but if it is a planned procedure, most doctors would ask you to contact Medical aid to request it. Information you need to get from the doctor before procedure are:
4. Payment and Claims: Once you are discharged, medical expenses will be paid directly to the hospital by the Medical Aid company, provided they are in compliance with your insurance plan. You might be required to pay a fee yourself, which is called a co-payment/deductible. For the doctor's fee, if you pay the doctor directly, you can later submit a claim to your Medical Aid provider to get a partial or full refund of the fee you paid, depending on your plan type. 5. Communication during the hospitalization: During the hospitalization, the Medical Aid provider may need to maintain communication with the hospital and your doctor to ensure that the treatment provided complies with the insurance plan's regulations. Please note that different Medical Aid plans may have different policies and procedures, so it is best to learn more about the benefits of the plan you choose before purchasing Medical Aid. In addition, depending on your Medical Aid plan, you may be required to pay certain co-payments and follow specific claims procedures. Therefore, it is recommended to contact your Medical Aid company or Medical Aid consultant for detailed information. If you would like to know more about what you are covered under your medical aid, please contact us. You may also read our article: What Is Covered In Your Medical Aid? for more information. |
AuthorKevin Yeh Archives
January 2025
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