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South Africa’s New Regulations on Medical Aid Industry

The medical aid industry saw a massive shake-up in April as National Treasury introduced new regulations which will see a limit on the amount of gap cover and hospital cash-back policies you can claim, as well as the discontinuation of all primary healthcare policies.

This is was done in an effort to differentiate between “medical scheme products” and “health insurance”, both of which are regulated by separate Acts causing confusion in the medical arena.

The new regulations will now outlaw all primary healthcare policies from 1 April. According to legislation these are not seen as full medical schemes, instead providing limited medical service benefits, such as GP visits, basic dentistry and optometry, and some acute and chronic medication.

The new laws also stipulate that hospital cash-back plans are limited to paying their clients a maximum of R3,000 per day, or a total lump sum of R20,000 per year. Currently there are no limits in place for these payments.

The regulations, which were demarcated in terms of the Long-term and Short-Term Insurance Acts, came into effect as of 1 April 2017 for new policies and retrospectively from January 2018 for existing policies.

Affordable options
South Africans looking to avoid free public healthcare and turn to private health are most accustomed to medical aids to see them through. But even at their cheapest, medical aids can cost over R1,000 a month – which is something the vast majority of South Africans can ill afford.

Cheaper alternatives exist in the form of health insurance products, which often cater to a more specific type of cover (hospital, or day-to-day cover for example) at a reduced price.

Beyond the big medical aid brands, such as Discovery, or Bonitas, smaller insurers play in this field. These include companies like Affinity Health and Essential Med, who offer more affordable packages, catered to individual profiles.

Cover from smaller brokers can vary from R330 per month for a single member (covering day-to-day) to over R800 for more comprehensive cover.

Venturing past these amounts, consumers tend to enter medical aid territory. Below, are the cheapest offerings from range of major medical aid brands in South Africa.

Prices were correct at time of writing. This is not an exhaustive list of all the products on the market but should work as a comparative tool.

Hospital Plan
A Hospital Plan will cover all the services provided in a hospital including the anesthetist and surgeon. You would have to be admitted to a hospital, out patients and trauma units are generally not considered a hospital event if you are not admitted.

Health integration in South Africa should bridge the gap between the under-resourced public and wealthy private sector. But the country's National Health Insurance scheme, which aims to do this, is moving slowly and is riddled with infrastructure and co-ordination problems.

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