Too ex­pen­sive

Finweek English Edition - - LETTERS -

I RE­FER TO your re­port of 23 June and the letter from RJ de Wet (30 June). The big­gest prob­lem with our med­i­cal aid schemes is the gen­eral pub­lic and most mem­bers seem to be most ig­no­rant of the real is­sues. I think most mem­bers just can’t or don’t want to be both­ered with the de­tails. Many, of course, aren’t lit­er­ate enough to un­der­stand the ba­sics of med­i­cal schemes’ modi operandi.

RJ de Wet also of­fers some ig­no­rance, in that he quotes bro­ker com­mis­sions of 8% to 17% while they’re lim­ited by law to 3% of mem­bers’ con­tri­bu­tions. Bro­kers have for years been ac­cused of “milk­ing” schemes, yet way back in the early 2000s the then min­is­ter of health – Dr Nkosazana-Zuma – put a limit to med­i­cal aid bro­ker com­mis­sions. And just in case there’s a mis­un­der­stand­ing, I’m not a bro­ker but em­ploy one. Ad­min fees are a nec­es­sary evil: you can’t run an of­fice on noth­ing.

Med­i­cal schemes are “non-profit” or­gan­i­sa­tions: they’re owned by their mem­bers. Of course they make in­vest­ments: they can’t just keep con­tri­bu­tion mil­lions in a sim­ple bank ac­count – that would cost its mem­bers. I also re­ceive the an­nual re­ports from my scheme and in­vi­ta­tions to AGMs, which are held at var­i­ous lo­ca­tions coun­try­wide to en­able mem­bers to at­tend.

Then we go to the Old Mu­tual Ac­tu­ar­ies & Con­sul­tants (OMAC) find­ings: the ig­no­rance raises its head again, be­cause many mem­bers are sold the idea of “com­pre­hen­sive” cover – prob­a­bly the big­gest prob­lem of all. What was com­pre­hen­sive 30 years ago is no longer com­pre­hen­sive. At best, schemes cover 150% of doc­tors’ bills and when a doc­tor, sur­geon, etc, charges more, the mem­ber pays the short­fall. A few op­tions cover up to 200% but above that the only way out is ex­tra “topup” in­surance – which, in­ci­den­tally, Dr Zuma tried to out­law.

Then there are some lim­its, ex­clu­sions, etc, de­pend­ing which op­tion you have.

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