High Medical Aid Premium Increases Ahead

Medical aid scheme membership will cost more in 2016, with most schemes likely to increase premiums at above-inflation rates.

Three major medical schemes have announced their increases, all above the 4.7%  consumer inflation rate.

They are:

  • Discovery – 7.9% or 8.9% increase
  • Bonitas – 10.9%
  • Momentum – 8.9%

Bobby Ramasia, principal officer of Bonitas, told HospitalPlanQuotes.co.za that the increase was due to price pressure.

He said that not enough young, healthy people were joining medical schemes, while claims were increasing at a rate of 11% per years.

Medical Aid Premium IncreasesMedical schemes are not-for-profit organisations that require young, healthy members to subsidise the elderly and sick.

Jill Larkan, of GTC Healthcare, said cash-strapped consumers often bought cheaper medical aid options or hospital plans.

Larkan had some tips for consumers:

  • Understand that a medical aid option that covers 100% of medical aid rates does not mean 100% of your hospital bill will be paid.
  • 100% means that they pay their 100% of the price they set for doctors and if doctors charge above it, patients may have to pay in.
  • If you are in hospital, ask nurses, medical aids and brokers if your condition is covered as a prescribed minimum benefit. These are chronic conditions and diseases in which doctors have to be paid in full and for which certain medications have to be provided to the patient.
  • Understand if your medical aid requires you to use a network GP, network specialists and/or network hospitals – or all three. If they do, and you use alternative doctors or hospitals, medical aids will not pay the bill in full.
  • Gap cover is an insurance policy costing about R100 a month that covers the difference between what medical aids pay doctors for in-hospital treatment and what the doctors in hospitals charge.

With more and more people unable to afford full-blown medical aid membership, many are turning to hospital plans, which usually cover hospital stays and specialists’ fees.

Medical schemes have started to offer hospital plans too. These are preferable to cash back hospital plans from insurance companies as, by law, medical schemes must cover a wide range of Prescribed Minimum Benefits with every plan they offer.