South Africa’s Medical Arena Clouded by Confusion

Medical scheme products and health care insurance is causing confusion in medical arena. On the horizon are two new regulations for the medical scheme industry. There will be limits on Gap Cover and hospital cash back policies.

Significantly, they will discontinue Primary health care policies. Importantly, this decision has been made to differentiate between health insurance and medical scheme products. These are regulated by separate Acts.

Therefore, the new regulations will become effective at the beginning of April 2017. For new medical policyholders and from the beginning of 2018 for existing policyholders. They affect both long term and short term insurance Acts.

Outlawing primary health care policies

confusion in medical arenaThey will no longer legally accept primary health care policies from 1 April 2017. They will not view these policies as full membership of medical schemes. Some acute and chronic medication, as well as basic dentistry and optometry benefits. The limited scale of benefits allowed membership at a substantially lower monthly contribution than comprehensive medical schemes or hospital plans.

The Confusion in Medical Arena Will Affect you

Although people consider medical aid schemes a benefit only available to the affluent, this might change. Ideally, new medical health care regulations should improve standards of accessibility to all people in South Africa. However, until the country’s new primary health care legislations become effective. And thousands of South Africans are facing expensive loss in medical benefits.


Holders of primary health care policies should have been told about the new legislation. So primary health care policyholders should contact their insurers immediately if they are uncertain about the future of their health care cover.

Cash back plans and Gap Cover

At present, there are no limits to either cash back plans or gap cover, depending on the medical insurance cover selected. But now, according to new regulations, cash-back plans will have a maximum of R3 000 daily or an annual R20 000 lump sum payment. The limit on gap cover policies will have a limit of R150 000 per annually.

The cost of medicine

The growing cost of medication is placing increasing pressure on the medical scheme industry. And the key objective of pharmaceutical companies is the development of generic medicines to curtail the costs involved with medication.

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All info was correct at time of publishing