Downgrading Medical Aid and Saving on Health Care Costs

    People are downgrading medical aid cover, from an affordability issue. People can no longer afford full cover at the current rise in medical aid prices. This will also leave you with only two possible options. Either you will have to pay for the shortfall out of pocket. Or you will have to take out additional cover to pay for the gap.

    Is it legal – Downgrading medical aid

    Supreme Court ruling in the matter between Guardrisk Insurance Company Limited and the Registrar of Medical Schemes. The Court’s decision was final; there was a definite need for Gap cover insurance. Thus there is why they should not allow it.

    Is it affordable – Downgrading medical aid

    Downgrading Medical Aid

    Medical specialists and Private Hospitals can charge any amount they see fit. Thus the medical aid societies cannot pay the total bill. The insurance industry has provided an affordable solution to cover the Gap.

    The emphasis here is on the fact that the Insurance cover is affordable. If the medical aid societies were also trying to provide full cover at an affordable rate. The would not have been a niche in the market for Gap Insurance.

    Are these policies forcing people to take less Medical Aid Cover?

    No, the main issue is that of affordability. As schemes become more expensive, members have no other option to downgrade their medical cover. Because they simply cannot afford it anymore.

    Also, they do not take Gap cover as an alternative. It is rather as an affordable supplement to cover the shortfalls created within the Medical Aid industry, through consistently high rate increases and uncontrolled Tariff charges by Specialist practitioners and Private Medical Facilities.

    Are Medical Aid Societies /Medical Practitioners/Private Medical Facilities responsible for the need for Gap cover. It is not entirely clear who is responsible. Nor is it likely that only one sector of the Industry is responsible for the escalation of costs well ahead of inflation.

    That has also resulted in a gap that has been created between Medical Aid Society cover limitations and those fees raised by Specialist Practitioners and Private health Care facilities. There is much criticism levelled at them all, and it would seem with fair foundation.

    The reality is that Gap Insurance Cover would seem to be here to stay until such time as a more affordable system can be agreed, or standardised tariffs enforced by Government.

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