The National Treasury has launched two new medical scheme regulations which will see a cap on the amount of gap cover and hospital cash-back policies you can claim, as well as the discontinuation of all primary health-care policies. These new regulations have been put in place to distinguish between medical scheme products and health insurance, both of which are regulated by separate Acts causing uncertainty in the medical arena.
The regulations, which were demarcated regarding long-term and short-term insurance acts, will come into effect as of 1 April 2017 for new policies and retrospectively from January 2018 for existing policies.
The new regulations specify that hospital cash-back plans are limited to paying their clients a maximum of R3000 per day, or a total lump sum of R20 000 per year. Currently, there are no limits in place for these payments. Gap cover policies will now also be restricted to a payout of R150 000 per annum, per client. These changes are in place to try and prevent doctors from charging high rates as they have no need to compete on either price or quality in order to attract patients.
What does this mean? This should equate to you actually paying less as doctors cannot take advantage of you and your hospital bill. Although, complications can arise if you have a valid reason to surprise the hard limits introduced by the regulations, depending on your current plan.
Further changes will have to be made to the Schemes Act to address this issue, but in the meantime, those who cannot afford to make the jump could be left in the dark.