Since July 2010 with the demise of the National Health Reference Price List (NHRPL), there has been no uniform standard for medical aid tariffs.
The healthcare industry in South Africa, as well as the general public, also refers to medical aid tariffs as “medical aid rates”. There has been no uniform guide for medical schemes on which to base their tariff structures. Accordingly, as from the 2011 benefit year, medical schemes have been left to devise their own tariff and rates structures.
Genesis Medical Scheme has established its 2011 tariffs (“Scale of Benefits) as set out below:
- the formerly known NHRPL list in respect of relevant health services determined and published by the Department of Health that was in operation on 1 July 2010, adjusted with medical aid inflation for 2011, or
- the fee determined in terms of any agreement between the Scheme and the service provider(s) in respect of the payment of relevant health services. The above 2011 tariff guide structure was adopted by the majority of medical schemes and is used as a guideline to determine the rate at which they pay healthcare providers on their members’ behalf.
With the scrapping of the NHRPL in 2010, the entire industry was left with much uncertainty around pricing and tariffs, with no control over what service providers may charge their patients. It is therefore imperative, when consulting a doctor (or any other service provider), that members of medical schemes make a point of understanding what they are being charged for. Claims statements should be monitored closely and any irregularities or discrepancies should be queried with the respective service provider(s). Members should establish upfront what portion of the account will be covered by Genesis and what amount would be for your own account. Always try to negotiate discounts with your service provider so that he/she will not charge you more than what Genesis will cover.