Gap cover, primary healthcare and cash-back: New medical aid scheme regulations explained
National Treasury has announced its new regulations governing medical aid in South Africa, so here are three of the biggest changes we’ll have to get used to in 2017.
If you’re currently paying medical aid you’d know how big a part of your monthly budget goes to making sure you have the best possible cover for what you can afford. In an effort to clarify the different medical cover options available to us — we’ve currently got two different acts governing medical insurance products and medical scheme products –, treasury has introduced a few very important new regulations that should help things along.
First off, all hospital cash-back plans will now be capped at a total lump sum of R20 000 once-off per year, or a maximum of up to R3 000 per day; and gap cover payouts will also be limited to a total of R150 000 annually. Both of these currently have no legislated limits.
The idea behind regulating cash-backs and gap cover is to stop doctors from over-inflating their fees on the basis of additional cover paying out to their clients.
Finally, under the new regulations, all primary healthcare policies will be illegal as of April 1 2017. Government does not see these as complete medical schemes and they offer very limited cover including dentistry, visits to the doctor and limited chronic medication.
While these do offer much-needed benefits to those South Africans with a limited budget, they’ll have to make another plan soon.
The regulations mentioned above will come into effect as of April 1 2017 for all new medical aid policies and January 1 2018 for existing members.
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