NHI, Medical Schemes and the Health Commission
“Everybody’s talking”. Remember the song that was sung by Harry Nilsson in 1969?
Can your doctor justify his fee?
What is reasonable? Members of Genesis may remember that the Scheme launched an application to the High Court to have regulation 8 to the Medical Schemes Act (“the Act”) struck down. Regulation 8 is the provision of the Act used by the Registrar of Medical Schemes to force medical schemes to pay any amount claimed…
Cost of top 10 open medical scheme hospital plans in SA
Annually, GTC (formerly Grant Thornton Capital), a diversified financial services company, publishes an in-depth investigation into the array of medical aid plans and benefits. Their GTC Medical Aid Survey originated from the need to make informed recommendations to their clients on preferred plans and benefits for the following year. The GTC Medic al Aid…
Part 2: Battle with PMB demystified
Regulation 8 – unplugged As we mentioned in our recent article (Read it here), the issues and complexities around regulation 8 and section 29(1)(p) of the Medical Schemes Act (MSA) and the interpretation thereof in respect of the payment of Prescribed Minimum Benefits (PMBs) are complex. In addition, the interpretation and application of regulation 8…
“National Savings Month” and your medical scheme
July is National Savings Month “National Savings Month” is an awareness campaign run by the South African Savings Institute (SASI). July is always the month in which the national savings awareness campaign is run. It was first launched in 2001 by the then Finance Minister, Trevor Manuel. SASI aims to cultivate an environment of savings…
Part 1: Battle with PMB demystified
Regulation 8 – unplugged So, what is all the fuss about regulation 8? The answer is, unfortunately not straightforward. To start at the beginning, section 29(1)(p) of the Medical Schemes Act compels medical schemes to pay in full for any PMB condition that is treated at a public hospital. So far so good because public…
Medical aid brokers – is the commission model wrong?
The Medical Schemes Act, 1998 (Act No 131 of 1998) prescribes that commission payable, by a medical aid scheme to a healthcare broker, must be based on monthly contributions payable by the member. With effect from 1 March 2015, the rate of commission has been adjusted to 3% of monthly contributions up to a maximum…
VIP Patient on affordable medical aid
A heavily pregnant lady arrived at hospital admissions wanting to be admitted. “I am a member of a very large medical scheme. Please take me to my VIP suite bed with sea view reserved exclusively for members of my very big medical scheme”, she said. “Sorry madam”, came the reply, “all beds are owned by…
Silly Season never ends
Here we are well into 2015. The year has started badly with the senseless death of innocent people in Paris – some of whom were merely expressing an opinion. It is sad how intolerant so many people have become over the views of others. Then of course we have others that express views and opinions…
Mediese Skemas – Makelaars Kommissie-verdiense
Mediese fonds makelaars bly steeds ietwat van ‘n “warm besprekingspunt” te wees, veral aangesien ‘n paar onlangs die mening in die media en op sosiale platforms uitgespreek het dat kliënte kleiner mediese skemas moet vermy. Hul “boodskap” is dat slegs die grootste mediese skemas met sekerheid u eise kan betaal – ‘n baie vreemde gedagte,…
Medical aid membership and your broker
Medical aid brokers continue to be something of a “hot topic”, particularly as some have recently expressed opinions in the media and on social platforms that customers should avoid smaller medical aid schemes. Their “message” is that only the largest medical aid schemes can safely pay your claims – a very odd sentiment given that…
Be clever when it comes to medical aid tariffs
Since July 2010 with the demise of the National Health Reference Price List (NHRPL), or “medical aid rates” as most people know it, there has been no uniform guide for medical schemes on which to base their tariff structures. Accordingly, for the 2011 benefit year, medical schemes have been left to devise their own tariff…