How the NHRPL Medical Aid Rates and Tariffs Work
April 26, 2020
The price of medical aid is something most of us have to consider at one point or another of our lives. Be it deciding on whether to enquire about generic medicines. Or which health professional to consult or which health aid scheme best meets our personal health requirements. In this article, we will look at medical aid rates and tariffs.
There is some difficulty in comprehending the calculations that make up the tariffs for medical aid. In particular for those unfamiliar with health aid jargon, as well as acronyms like MMPA, PMB, ICD-10, NHRPL and BHF.
All these terms carry particular meaning, useful when determining information on offer, from health aid providers and medical practitioners.
MSR makes medical payouts that are different from one scheme to the next. Selfmed’s MSR is in line with the level cover and benefits of each plan:
- Hospital plan MedXXI: equal to 100% MSR.
- Selfsure: equal to 100% MSR.
- Med Elite (Comprises chronic cover): equal to 200% MSR.
- Selfmed 80%: equal to 100% MSR.
South African Medical Aid Rates – Medical Aid Rates and Tariffs
Three tariff guidelines characterised South African medical aid prices. Until recently: the NHRPL, the ethical health rates of the HPCSA (Health Professions Council of South Africa) and the BHF (Board of Healthcare Funders) rate list. January 2004 saw the discarding of the BHF price list. And the HPCSA concluded publishing, in December 2008, of its suggested pricing, leaving the NHRPL as the sole tariff structure.
The Tariff List of the Board of Healthcare Funders
The BHF’s recommended tariffs were arrived at through negotiations between it and the SAMA (South African Medical Association).
This tariff list was to be a Competition Act infringement, an act that regulates competitor activities between organisations and businesses. The NHRPL’s rates took over from the BHF’s rates, which ceased publishing its recommended medical rates. According to Heidi Kruger, a BHF spokeswoman, they fully support the NHRPL tariff determination process.
NHRPL (National Health Reference Price List) – Medical Aid Rates and Tariffs
The NHRPL was conceived by the CMS (Council of Medical Schemes), at the behest of the Department of Health. The list contains no negotiated prices; rather through a gathering of all health service disciplines’ suggestions on typical medical practice running costs.
So the NHRPL process does not pertain to them. Pricing on a hospital by hospital basis until which time the Department of Health and the Hospital Association of South Africa come to an agreement on a process by which to arrive at hospital tariffs.
So there is at times a difference between actual medical practice charges and the NHRPL. Also, it is more of a guideline for health aid schemes and practitioners to come to a mutually beneficial tariff scheme. Agreeable to insurance policy holders.
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All info was correct at time of publishing