Medical aid price-hike woes

Consumers warned of above-inflation increases next year CONSUMERS will have to budget more for medical aids next year, with above-inflation increases likely for most schemes.

Three major medical aids have announced their increases for the new year and they are all above consumer price inflation, which is sitting at about 4.7%.

Discovery Medical Health Scheme is increasing by either 7.9% or 8.9%, depending on the member’s medical plan.

Bonitas Medical Scheme said its options were increasing by about 10.9%.

Momentum Health Medical Aid’s average increase will be 8.9%.

Healthcare costs usually increase above inflation, but salaries do not.

Bonitas principal officer Bobby Ramasia said yesterday the increases were due to price pressures on medical aids.

“As reported by the Council for Medical Schemes [the medical aid regulator], the market has not been successful in attracting young, healthy people to join medical schemes, while expenditure on claims continues to increase at a rate of more than 11%.”

Medical aids are not-for-profit trusts, with money pooled and shared for the sickest members.

They require younger, healthier members who claim less to subsidise the sick, but most medical aids last year, with the exception of Discovery, did not grow.

GTC healthcare consulting head Jill Larkan said cash-strapped consumers often bought cheaper medical aid options to balance their budgets.

Larkan, had some tips for consumers:

• An option that covers 100% of medical aid rates does not mean 100% of your hospital bill will be footed. The 100% option means that medical aids pay 100% of the price they set for doctors and if doctors charge above it, patients may have to pay in.
• If you are in hospital, ask nurses, medical aids and brokers if your condition is covered as a prescribed minimum benefit. These are chronic conditions and diseases which doctors have to be paid for in full and for which certain medications have to be provided to the patient.
• Establish if your medical aid requires you to use a Network GP, Network specialists and/or Network hospitals, or all three.
• If it does and you use alternative doctors or hospitals, medical aids will not pay the bill in full.
• Gap cover is a roughly R100a-month insurance policy that covers the difference between what medical aids pay doctors for in-hospital treatment and what the doctors in hospitals charge.