After years of delays, the Council for Medical Schemes is to publish a framework for low-cost medical scheme options next month, says a report in Rapport. Medical schemes hope the low-cost options exclude the current Prescribed Minimum Benefits (PMBs) in order to offer genuinely affordable options.
The council says the framework will be published alongside a draft PMB document for preventative care services. The current PMB legislation deals only with treatment for the listed conditions and emergencies and not preventative services.
According to the report, Profmed’s Graham Anderson estimates more than 6m people would benefit from a low-cost option. Wicus Kotze, of Bestmed, says the problem with the current regime is that the basic plans, such as their lowest “hospital plan”, still has to provide cover for treatment of all the PMBs in and out of hospital, making it unaffordable for many people. Their lowest plan costs more than R1 300 a month for a single member.
According to the latest report by the council, 49% of all risk claims paid out by schemes in 2017 was for PMBs. Each individual belonging to a medical scheme paid on average R746 per month just to cover PMBs.
Rapport report Subscription needed