What's Happening?

Facebook Twitter Youtube Linkedin

NEED HELP? QUESTIONS@FIA.ORG.ZA

become A FIA member TODAY
member login

Further healthcare reform set to shake-up medical industry

ARTICLE BY

  • Wendy Bussey

SHARE THIS POST

The views expressed in this article are not necessarily those of the FIA. The article below was supplied by 2018 FIA partner, Lombard Partnerships.

President Cyril Ramaphosa has recently discussed what we are all thinking: SA’s healthcare system is in crisis. Addressing union members in June, Ramaphosa is quoted as saying: “Right now our hospitals are burdened and our healthcare is in crisis, and we believe the only way to correct this is to pool all resources and everyone makes a contribution.”

There seems to be an endless flow of bad news surrounding public healthcare across the nation. Recent wildcat strikes by healthcare workers at Charlotte Maxeke Academic hospital left a trail of destruction. Klerksdorp’s Tshepong Hospital saw patients being intimidated by violent protesting workers. Kwa-Zulu Natal suffers from a dire lack of oncologists and equipment – leaving cancer patients on heartbreakinglong waiting lists.

And of course, we cannot forget the deaths of 144 psychiatric patients when they were transferred from Life Esidemini to 27 NGOs.

To resuscitate our healthcare system, Government is proposing the concept of universal healthcare, where over R250 billion per annum is to be made available – via various funding mechanisms – to provide quality healthcare services to all citizens. It hopes to implement the new system by 2026.

Universal healthcare gained momentum earlier this month, with Cabinet approving the National Health Insurance (NHI) Bill – which helps to pave the way for universal healthcare.

Demarcation

But the new legislation will also change the way that Medical Aids and others in the medical insurance industry provide services. While details are still forming and emerging, Health Minister Aaron Motsoaledi has indicated the plans include the abolition of Medical Scheme co-payments and the monthly broker fees, as well as the removal of waiting periods and late joining penalties.

The outcome of these bills, as well as the thorough review of the prescribed minimum benefits (those medical services that Medical Schemes are forced to cover), may entirely reshape the medical industry.

Already, the sector has seen positive reform in recent times, with the new ‘demarcation’ regulations clarifying the role of Medical Aids versus other Medical Insurance products (including the likes of Gap Cover, Dread Disease Cover, Hospital Cash Plans, Medical Travel Insurance and Primary Healthcare insurance).

When it comes to Gap Cover providers, demarcation includes these key provisions:

  • Gap Cover providers must follow the same underwriting requirements as Medical Schemes – including open, non-discriminatory enrolment and waiting periods for specified pre-existing conditions.
  • Gap Cover benefit limitations are capped at R150 000 per annum, per person.
  • Greater transparency governing the relationships between client, broker and insurer of Gap Cover (with a fixed, sliding scale, commission rate of between 5% and 20%).
  • No discrimination based on one’s state of health (pricing can be age-related, but that pricing must then be applied to all new clients in that age range).

Personal finances under pressure

Demarcation has helped to better protect and educate customers that weren’t always aware of the benefits offered by the various health insurance offerings, as opposed to traditional Medical Aid schemes.

At times, consumers would be confused between a medical aid and insurance offerings. But now, the arrangement is much clearer, and customers can more easily see the role of a Medical Aid and the benefit of combining it with the appropriate supplementary Gap Cover.

While the universal healthcare plans may further alter the way that Medical Aids and Gap Cover providers operate, most experts believe that private healthcare services and insurance will certainly continue in some shape or form.

In fact, considering the fact that taxpayers will ultimately have to fund any new universal healthcare fund, we can expect a further crunch on our personal finances. This leaves most of us in no position to afford massive out-of-pocket private medical expenses, further underscoring the importance of Gap Cover to insulate us against medical expense shortfalls.

Many of those accustomed to the quality of private healthcare will be sceptical of public healthcare services, even if they’re improved and expanded under the new vision for universal healthcare. For brokers, it will be about selecting Medical Aid and Gap Cover combinations that suit the needs of every individual customer, while ensuring maximum value from their monthly premiums and contributions.

Subscriber Terms and Conditions

  1. APPLICATION OF TERMS
    • These terms and conditions (“Subscriber Terms”) apply to the subscription by any qualifying member of the South African Underwriting Managers Association NPC (“SAUMA”) to the services and benefits offered by FIA Services (Pty) Ltd (“FIA Services”) under the SAUMA affiliation arrangement (“Subscription”).

  2. NATURE OF SUBSCRIPTION
    • A Subscription under this arrangement:
      • does not constitute membership of FIA NPC;
      • does not confer any voting rights or governance participation in FIA NPC; and
      • is governed solely by the contractual relationship between the Subscriber and FIA Services.

  1. ELIGIBILITY
    • To qualify for the Subscription, the applicant must, at the time of application, be a current paid-up member of SAUMA.
    • FIA Services will verify the applicant’s SAUMA membership status with SAUMA prior to activation, and may re-verify such status periodically.
    • If a Subscriber ceases to be a paid-up member of SAUMA, the Subscription will correspondingly be terminated.
    • Applicants are required to authorise FIA Services to confirm their SAUMA membership status with SAUMA as part of the application process.

  1. SERVICES
    • The Subscription entitles the Subscriber to the following benefits:
      • Complimentary access to the FIA CPD Platform;
      • Complimentary access to the FIA Insight Magazine (digital edition);
      • Advertising opportunities on FIA platforms at a discounted rate of 15% (fifteen percent) off the prevailing published rates; and
      • Invitations to attend FIA Technical Webinars annually.
    • FIA Services reserves the right to update, vary or substitute the Services from time to time, provided that the overall value and nature of the benefits remain materially the same.

  1. FEES AND PAYMENT
    • The monthly subscription fee is R260.00 (two hundred and sixty rand) for up to seven registered individuals (Key Individuals and Representatives), and R36.00 (thirty-six rand) per additional registered individual thereafter, excluding VAT.
    • The Subscriber shall provide FIA Services with the required details of each individual to be registered under the Subscription for the purposes of activation and billing.
    • All fees are exclusive of VAT, which shall be charged at the prevailing statutory rate.
    • Subscription fees are reviewed annually in March and may be adjusted with effect from 1 April.
    • Any changes to the Subscription, including but not limited to the number of Representatives and Key Individuals registered under the Subscription, may only be effected once annually during the annual review period in March of each year, with such changes taking effect from 1 April.
    • Subscription fees shall be billed monthly in arrears, unless the Subscriber elects an annual billing cycle at the time of application.
    • The Subscriber shall ensure that all billing information (including contact details, authorised signatories and bank account details) is kept accurate and up to date.
    • Non-payment of subscription fees may result in suspension of access to the Services until such fees are brought up to date.
    • The Subscriber acknowledges and agrees that all subscription fees payable under these Subscriber Terms may be collected by way of debit order, which shall be processed by the holding company, FIA NPC (The Financial Intermediary Association of South Africa), on behalf of FIA Services. Payment to FIA NPC shall be deemed to constitute valid and sufficient discharge of the Subscriber’s payment obligations to FIA Services under these Subscriber Terms.

  1. ONBOARDING
    • Onboarding will be conducted as a Subscription with FIA Services under the SAUMA affiliation arrangement.
    • Onboarding will not confer FIA NPC membership status or any associated rights.
    • Onboarding is conditional on confirmation of the Subscriber’s current SAUMA membership at the time of application

  1. DATA PROTECTION
    • FIA Services will process all personal information in accordance with the Protection of Personal Information Act 4 of 2013 (POPIA) as set out in our POPIA policies.
    • By subscribing, the Subscriber authorises FIA Services to confirm their SAUMA membership status with SAUMA and to process personal information for the purposes of fulfilling the Subscription.

  1. TERMINATION
    • The Subscriber may terminate the Subscription by giving FIA Services one calendar month’s written notice.
    • FIA Services may terminate the Subscription on one calendar month’s written notice, or immediately if the Subscriber breaches these Subscriber Terms and fails to remedy such breach within 14 (fourteen) days of receiving written notice.
    • Termination of the SAUMA–FIA Services affiliation agreement shall not automatically terminate these Subscriber Terms.
    • Termination by the Subscriber shall not relieve the Subscriber of liability for any subscription fees accrued up to the effective date of termination.
    • FIA Services may suspend or terminate the Subscription with immediate effect in the event of non-payment of fees by the Subscriber.

  1. GENERAL
    • These Subscriber Terms are governed by the laws of the Republic of South Africa.
    • Any disputes arising under these Subscriber Terms shall be dealt with in accordance with the dispute resolution provisions contained in the FIA NPC membership terms and conditions, as modified to reflect that the contractual relationship is with FIA Services.
    • Any notices required under these Subscriber Terms may be validly delivered by email to the addresses provided in the Subscriber’s application form, and such notices shall be deemed received on the day of transmission if sent during business hours.
    • The Subscriber may not assign, cede or transfer any of its rights or obligations under these Subscriber Terms without the prior written consent of FIA Services.
    • No variation of these Subscriber Terms shall be of any force or effect unless reduced to writing and signed by both FIA Services and the Subscriber.