Low Cost Medical Scheme Spells R-E-L-I-E-F

    A proposed low cost medical scheme spells R E L I E F for many cash strapped South Africans. In some countries you might think about going without a medical aid, but in South Africa, being without a medical aid is like signing your own death certificate. Many state hospitals in the country can’t even provide basic care, let alone specialised surgery. This below-standard medical attention can often mean your next visitor being a funeral director as apposed to preparing to return to work and to everyday life.

    Low Cost Medical Scheme – Hope for Low-Income Working on the Horizon

    Having medical aid is the difference between life and death in South Africa, and now there is hope on the horizon. The Council for Medical Schemes (CMS) is working to provide a medical scheme for low-income workers as early as next year. This information emerged at the annual Board of Healthcare Funders (BHF) conference recently. The Council for Medical Schemes has also laid out the mandatory requirements for schemes wishing to offer low-income workers a cheap but watered down version of the products currently on the market.

    Low Cost Medical Scheme – Basic Benefit Options for South Africans Earning below R70 700

    The CMS is a statutory body which regulates the medical schemes industry. They are hoping that this new low cost medical scheme is going to bring in new members. They reckon that in South Africa today there are in the region of 6-million people in formal employment who can’t afford medical scheme coverage. These people together with their dependents represent an untapped potential market of 15-million beneficiaries.

    Head of benefits management, Paresh Prema said that the regulator had consulted the industry to develop a set of proposals which would be presented to the CMS. If the Council for Medical Schemes approved this, it would open the way for medical schemes to offer basic benefit options that would cost as little as R200 per person each month. Paresh Prema said that the CMS has already received 12 submissions from medical schemes and administrators.

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    South Africans who earn below the tax threshold – R70 700 are the one who will qualify for this new low cost benefit medical scheme option. Medical schemes are submitting applications for certain exemptions from the Medical Schemes Act. Every scheme applying for the registration of such an option will do the detailed design of its option. This includes the cost, which will be submitted to the Council for Medical Schemes for approval.

    Low Cost Medical Scheme – What’s Included and What is Exempted

    The Council for Medical Schemes says the options will cost in the region of R180 and R300 for each beneficiary each month. This low cost medical scheme is aimed at those who haven’t been able to afford a medical aid in the past. The low cost benefit option will be exempt from medical emergencies, prescribed minimum benefits, including 26 chronic conditions, and the 270 conditions medical schemes are required by law to cover to a minimum standard.

    Just one or two of the benefits the scheme will be required to offer, include –

    ● some radiology
    ● one eye test and basic set of glasses every 2 years
    ● 1 out-of-network visit for each beneficiary each year
    ● 5 consultations with network GPs etc per beneficiary per year
    ● preventative healthcare, including blood pressure tests, cholesterol, influenza vaccine etc
    ● 2 consultations for basic dentistry per beneficiary per year
    ● emergency road transport

    Low Cost Medical SchemeLow Cost Medical Scheme – The Focus is on Preventative, Primary Healthcare

    A medical aid will ensure that you and your family are able to pay for- and get adequate medical treatment from a specialist and in a clean, hygienic hospital environment. In South Africa it is important to insure your health.

    Accidents and ill health are unpredictable. Those who haven’t been able to afford comprehensive cover, have settled for a hospital plan. Now with a low cost medical scheme on the horizon , South Africans are looking forward to low-cost benefit options which will focus on preventative, primary healthcare and where members will use a network of providers, but will be guaranteed they won’t have to contend with any co-payments.

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