New SA medical aid amendments will change your life

Minister of Health Aaron Motsoaledi on Thursday explained the expected impact of the new Health Insurance Bill and Medical Schemes Amendment Bill at the Government Communication and Information System (GCIS) building in Pretoria.

The amendments, which have been approved by Cabinet, will be game changers for the way health insurers treat South Africans.

Starting with the Medical Schemes Amendment Bill, Motsoaledi explained that the first amendment in the new bill did away with co-payments, meaning insurers would no longer be allowed to expect those undergoing medical procedures to pay a portion of the bill. Instead, the entire cost of procedures will have to be forked out by the medical aid company.

The cost of these co-payments to South Africans is R29 billion in total, according to the minister.

In defence of the change, Motsoaledi said the health department had data showing that medical aid schemes were withholding close to R60 billion in reserves – amounting to 33% of the total reserve. He added he believed high premiums charged by medical aid companies contributed to this large sum.

A second amendment in the bill does away with brokers.

According to Motsoaledi, almost two-thirds of South Africa’s medical aid clients pay a monthly sum to a broker without knowing it. He added the money paid to brokers should instead be used to serve the needs of patients.

A third amendment will abolish the prescribed minimum benefits offered by health insurers and replace it with comprehensive health benefits.

Other amendments will see the rich subsidise medical aid for the poor, the young subsidise the elderly and the healthy subsidise the sick; medical aids passing back savings to clients; and the establishment of payments relating to late joining age.

Motsoaledi then went on to explain the National Health Insurance Bill. It is “a health financing system that pools funds to provide access to quality health service for all South Africans based on their health needs irrespective of their socioeconomic status”.

The act will establish a fund that aims to achieve sustainable universal access to healthcare services.

While 12 bills will be amended to achieve this, the minister focused on two amendments – to the National Health Act of 2003 and the Mental Health Act of 2002.

He said these amendments were recommended by the Health Ombudsman following the Life Esidimeni disaster.

Motsoaledi dismissed speculation that the new bill plans on destroying private healthcare as untrue.

The health minister also mentioned in the briefing that he did not believe that legally, medical aid companies were meant to be turning a profit.

Motsoaledi has appointed Justice Sandile Ngcobo to conduct an inquiry into the rising cost of health care. The minister said that those findings would be released on June 28, and mentioned that certain groups were rumoured to be trying to interdict those findings.

At the briefing, Motsoaledi also quoted the WHO statistic that only 10% of South Africans had access to health care.

The changes mentioned by Motsoaledi should have a huge positive impact on not only existing medical aid consumers, but on those who do not have access to proper medical care, if implemented properly.

While the amendments are great on paper, an expert on health insurance who asked not to be named said “the law of unintended consequences could kick Motsoaledi in the teeth”.

It is predicted that medical aid companies will slam the changes. The Citizen will be looking to them for comment, and will update readers once it is received.