No set benefits for low-cost plans yet
Standardised benefits for low-cost medical scheme options are unlikely to be introduced for another two years.
Insurers will, in the absence of a standardised package, be allowed to offer you a confusingly wide range of plans that start at around R160 a month and offer cover for your day-to-day healthcare needs through private practitioners, but leave you relying on state hospitals for most admissions.
If medical scheme membership is too expensive for you, you could consider one of these so-called primary healthcare plans, as in return for a low premium they can give you access to a private general practitioner, basic medicines, x-rays and blood tests and sometimes even optometry and dentistry.
But without a standard set of benefits helping you to know what you are buying and to make meaningful comparisons, you have to stay wised-up to the potential differences in cover.
The plans cost between about R160 and R550 a month and the benefits are as diverse as the cost of the premiums.
To protect medical schemes the definition of the business of a medical scheme has been tightened up and these plans are now regarded as doing the business of a medical scheme.
The Department of Health, however, set the medical scheme regulator, the Council for Medical Schemes, the job of drawing up a standardised benefit package to allow these plans to continue under a general exemption from the Medical Schemes Act.
The idea was to exempt them from providing the prescribed minimum benefits as many of these benefits are expensive ones that cover in-hospital treatment.
While it considered what should be in this benefit package and how it should fit in with the government's future National Health Insurance plans, the council granted exemptions to a number of primary healthcare plans.
The exemptions expire at the end of this month, but the council has now instructed insurers providing these plans to apply for a further exemption that will last another two years.
This means you need to take care when you compare these plans as the benefits vary greatly. For example, some offer unlimited GP visits while others offer a set number of visits, or a set number of visits per year, after which you must pay a co-payment.
Most plans only pay for GPs who belong to a GP network - be sure you are happy to use those doctors. Many exclude specialist visits.
Cover for medicines may be limited to a rand amount and/or may exclude chronic or over-the-counter medicines.
Blood tests, x-rays, dentistry and optometry are usually strictly limited.
Some plans are combined with insurance policies that offer some strictly limited benefits for private hospital cover, such as stabilisation after an accident.
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