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.