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People with primary healthcare insurance policies may be forced to fork out three times the amount they are currently paying if they want to keep their medical insurance.
Primary healthcare insurance is similar to a medical aid policy, but costs a fraction of medical aid premiums, with some costing as little as R400 a month. This form of medical insurance will be phased out by April 2019.
In future, these products will be registered as medical schemes. This in accordance with new demarcation regulations published by Treasury last month.
Some primary healthcare insurance providers have expressed concern about this.
Richard Blackman, the chief executive officer of Day1 Health, told City Press on Friday that the demarcation regulations would deprive poor people of access to private healthcare.
“People take up primary healthcare insurance because they want to access private healthcare but cannot afford the conventional medical aid premiums, which are expensive,” he said.
“Now, the government is taking that right away from them and forcing them to either pay for medical aids or use the public healthcare sector.
“What is tragic is that the cheapest medical scheme options cost three times as much as – or even more than – what primary healthcare insurance policies cost.”
Primary healthcare insurance plans work in a similar way to medical aid schemes, but do not cover prescribed minimum benefits – the 270 life-threatening conditions which have to be covered by schemes at any cost.
With primary healthcare plans, a member has a limited number of general practitioner consultations, some acute and chronic medication benefits, and basic radiology, dentistry, pathology and optometry benefits.
According to Treasury, primary healthcare insurance policies are causing harm to medical aid schemes by attracting younger and generally healthier members away from them.
The department of health believes that, if left unchecked, this could result in increasing costs for older and less healthy members, who remain dependent on medical schemes for their cover.
Blackman said this is where the problem lies.
“You cannot force healthy people to subsidise the less healthy,” he said.
He described this demarcation process as a classic case of monopoly capital.
“The interests of the few medical schemes have captured the state to ensure their survival at the expense of the poor,” he said.
“Medical schemes know that, sooner or later, most of their members will leave and take up primary healthcare plans, which are provided at a far cheaper rate.
“Now poor people are being forced to either be members of medical schemes or use the public healthcare sector.”
The publication of the demarcation regulations is the result of a four-year consultative process between the ministers of finance and health, the Council for Medical Schemes (CMS), the Financial Services Board and other affected parties.
The regulations also deal with other insurance products – namely, hospital cash plans and gap covers – which will be restricted from next year.
The medical gap-cover insurance and hospital cash-plan benefits will be limited, while top-up cover will be banned from January next year.
The regulations limit insurers to offering hospital cash plans with benefits of up to R3 000 a day or a lump sum of R20 000 a year, and gap-cover policies with annual benefits of up to R150 000.
It is not clear how primary healthcare plans will be structured under the ambit of medical schemes. However, the health department has been asked to develop low-cost benefit option guidelines.
The current primary healthcare plans will be exempted by the CMS while the transition takes place.
