Low Cost Medical Aid Promises Relief for SA’s Lower Income Population
Low-cost medical aid for South Africans earning below the tax threshold is on the horizon.
Thanks to the Council for Medical Schemes (CMS), the road has at long last been paved to provide health care for all.
Who will qualify? – Low-Cost Medical Aid
People earning below the current tax threshold will qualify for low-cost medical aid.
Also, earnings are pegged at below R73 650 annually = R6 137 monthly.
Members must be no older than 65 years.
What will it cost?
The cost of these medical schemes will be in the region of R180 to R300 monthly for each beneficiary, also putting health care well within reach of most.
The way forward
Until the recent announcement by the CMS, medical schemes have found it difficult to offer affordable health care cover because of restrictive legislation policies.
So these included the provision of 270 Prescribed Minimum Benefits (PMBs), including 25 chronic conditions, which medical schemes must provide their members regarding legislation.
Also, the cost of including PMB’s has proven onerous, forcing medical schemes to increase monthly premiums well outside the reach of most of the population.
So with the publication of a new framework by the CMS, the door has been opened for medical schemes to register for the new low-cost options.
What are the benefits?
Low-cost medical aid will focus on the provision of primary care, including:
- Visits to general practitioners
- Provision of both medical and chronic medication
- Emergency road transportation
- Cover for 15 (of the 28) listed Chronic Diseases
- No deductibles or co-payments
Are there restrictive conditions?
- Members may have to undergo surgeries in State-run hospitals
- To keep costs low, members will have to use network providers stipulated by their medical scheme
- Penalties of up to 75% may be imposed for late joiners
- Waiting periods will be imposed
In-depth look at the benefits
- Five GP consultations within the network of service providers
- One outside consultation, including a visit to a GP, pharmacy, nurse or clinic
- Pre and post-natal care within the network of service providers
- Blood pressure, cholesterol and blood sugar tests
- HIV tests and counselling
- TB screening
- Ultrasound breast examinations
- Pap smears
- Prostate screening
- Influenza and pneumococcal vaccines
- Acute medication limited to the essential drug list
- Medication for 15 chronic conditions limited to the essential drug list
- Pathology tests limited to 53 specified conditions
- Four ultra-sounds
- One eye test
- One pair of prescribed single vision spectacles every two years
- Two visits to the dentist limited to 25 procedures
Low-cost medical aid will attract a huge membership base.
So health care is now within reach of all South Africans, most of who have to rely on State service providers.
Basic benefits such as eye testing and dentistry – generally not offered by State clinics – will be a bonus for thousands of people who cannot afford the services provided by the private sector.
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