Co-payment for Bonitas waived

BOON TO MEMBERS: FULL ACCESS TO HOSPITALS NOW

Struggling with rising costs, Bonitas informed its members 14 Life Healthcare hospitals were off-limits, but the hospital group would have none of that.

Life Healthcare claims it will not hold Bonitas Medical Fund members liable for certain co-payments related to admissions to a number of hospitals within its network.

The hospital group’s decision comes days after the medical scheme notified members on its BonComprehensive, BonClassic, BonComplete, BonSave, Standard, Primary, Hospital Plus, Hospital Standard and BonEssential healthcare plans that a 30% co-payment would apply to admissions and procedures carried out at 14 hospitals nationwide.

Chopping block

The hospitals – Bedford Gardens Private Hospital, Brenthurst Clinic, Carstenhof Clinic, Eugene Marais Hospital, Faerie Glen Hospital, Flora Clinic, Genesis Clinic (Saxonwold), Hilton Life Private Hospital, Kingsbury Hospital, Little Company of Mary Hospital, Rosepark Hospital, Vincent Pallotti Hospital, Wilgeheuwel Private Hospital and Wilgers Hospital – are part of the Life Healthcare Group.

According to Bonitas, hospital admission costs of R6 billion a year account for half of the scheme’s total claims expenditure.

“We used our increased size to our advantage and were able to negotiate more favourable hospital tariffs for the 2017 benefit year and beyond,” it said in a February 4 message to members.

Bonitas told Business the rates negotiated in 2016 should result in savings of R100 million in 2017. It has already increased member contributions by an average of 11.9% for the 2017 benefit year as claims rose. But the medical scheme was unable to strike a “favourable” deal across all of Life Healthcare’s facilities “and therefore, the scheme resolved to exclude 14 Life hospitals from being designated service providers”, explained Kenneth Marion, acting chief operating officer for Bonitas.

As a result, members would have to pay a 30% co-payment if voluntarily admitted to the hospitals for non-life threatening medical conditions. Marion said the medical scheme rules cater for a 30% co-payment for the use of a non-designated service provider.

The identified hospitals were all close to similar alternative facilities where no co-payment would be incurred. “We do not expect that the change will impact the level, quality or accessibility of care that members enjoy,” Bonitas wrote in an e-mail to its members.

Not lying down

In response, Life Healthcare said it would write-off the co-payment costs incurred by Bonitas members at the hospitals in question. “There will therefore be no financial impact on Bonitas members who utilise these 14 hospitals,” said Matthew Prior, a funder relations and health policy executive at Life Healthcare.