Have you considered what happens to you in the event of a car accident, workplace accident, the onset of disease or when you need to give birth? Have you made plans to cover healthcare-related bills? Do you have medical aid?
A harsh and sad reality for many South Africans is reliance on government-provided healthcare in a medical event because the fact remains – private healthcare is just too expensive and unaffordable for most South Africans.
Over the past year, we’ve seen the launch of a number of products that provide a level of healthcare coverage at a considerably lower cost than traditional medical aid. These products are predominantly designed for individuals who find medical aid contributions unaffordable. This move from the insurance industry has been in response to the Council for Medical Schemes (CMS) moratorium prohibiting Medical Schemes from providing low-cost benefit options (LCBOs). While these healthcare insurance products don’t replace medical aid, they offer valuable protection at a much lower price point. However, it is important to understand the benefits and limitations of these policies.
The high cost of medical aid is underpinned by legislation, which requires each medical aid option to provide cover for a list of Prescribed Minimum Benefits (PMBs), which cover a wide range of basic and advanced healthcare benefits. These benefits are expensive, and their cost, along with administration and other non-healthcare costs, represent a baseline below which no contribution rate can fall.
Primary Healthcare is a low-cost solution, healthcare insurance product. The primary care products vary across the different service providers, including collaborative offerings between service providers and retailers to allow for ease of access. When assessing the viability of medical aid against primary healthcare, it is important to know the limitations of primary healthcare cover. As Primary healthcare is an insurance product, it offers stated benefits and a list of medicines that may not necessarily cover Prescribed Minimum Benefits (PMBs), day to day cover or chronic condition cover.
A recent study by the Institute of Race Relations (IRR) shows that millions of South Africans aren’t covered by medical aid or basic healthcare provider. The report indicates that only 17.4% of South Africa’s population is covered by a Medical Scheme, leaving 82.6% of South African lives uncovered.
The leading barrier to private healthcare or medical aid cover in South Africa continues to be the cost, resulting in increased pressure on the public healthcare system. Employees without medical aid cover pose the business challenge of increased absenteeism rates, having to take leave for hospital or clinic visits, surge in sick leave and loss in productivity. To tackle this many businesses are now offering primary care cover to this cohort of economically active people who cannot afford medical aid, all at the cost of a can of coke per day.
The various products provide a wide range of varying benefits. Some provide a daily benefit for hospitalization, or a fixed sum for each time you need to visit a doctor or buy chronic medication.
Since there are many products on the market, each with different levels of cover, this makes it particularly difficult for consumers to review, interpret and select the most appropriate option for them. It is therefore vital that all employers and the broader medical aid industry have a critical role to play in protecting working South Africans from the financial consequences of unexpected health events.
We encourage employer groups to work with healthcare consulting specialists to identify the most suitable medical cover products in the market for their employees and to educate their employees on the exact benefits of each. These industry specialists are often able to negotiate a reduction in premiums, compared to what the employees would pay as individuals, and employers can generally facilitate payment via a payroll deduction.
Primary Healthcare is an affordable alternative for many South Africans who are unable to afford medical aid cover, providing access to quality healthcare and health cover for uncovered lives. Help your employees save on their basic right to access quality, private healthcare – at just a cost of a can of coke per day.
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