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How will the Medical Aid Rates Affect you in 2016?


How will the Medical Aid Rates Affect you in 2016?

Inflation, like death and taxes, has become an inescapable fact of life, not just in South Africa, but throughout the world. Every, year those who are responsible for running the world’s manufacturing and service outlets meet to plan the 12 months ahead, examining their projected expenses and exploring the various means that will be needed to meet these, while also providing them with both profits and growth. Almost invariably, the result is that consumers will be required to pay a little more than they did in the previous year for the same goods and services.

In such matters, the healthcare industry is no exception and, because it is a field that relies heavily on advances, notably in diagnostic and treatment technologies, it is often more exposed to the pressures of a growing operational budget than most of the nation’s other industries. Medical aid rates remain fixed for 12 months from the beginning of each calendar year, regardless of the month in which a given member may enrol and, with the advent of 2016, many schemes have since introduced their new scale of premiums.

Schemes, however, may not simply implement new premiums at will. Instead, they are required to submit details of their proposed increases along with any documented evidence that may be needed to justify their proposals. These submissions must be made to the industry’s regulatory body known as the Council for Medical Schemes or CMS. In its capacity as an arbiter, the Benefits Management arm of the council exercises the right to review and to authorise or to reject these proposals, in the latter case, calling either for some revision or for further evidence in support of the original proposal.

A great deal has been achieved by many fund managers in their efforts to protect their members from the growing cost of healthcare and the increases to medical aid rates that, as in previous years, many South Africans are now faced with in 2016. Among the most effective ways in which this has been achieved is through the appointment of a network of preferred and trusted service providers. Instead of maintaining a system in which members select their own clinics and specialists, costs may be reduced considerably by insisting that, wherever possible, members only make use of those retained by the scheme. In return for the captive market, the preferred suppliers offer a preferential cost structure that makes it far easier for a scheme to exercise control over its premiums.

By contrast, some schemes have chosen to adopt a policy of reducing benefits selectively as the means to keep a rein on their members’ monthly contributions. Whatever scheme you may choose, it is important to be guided by its value rather than by its cost. While you can be sure that all schemes are now mandated to offer the prescribed minimum benefits, it is those not required by law that should concern you. Whatever medical aid rates you may be called upon to pay in 2016, it is vital that the benefits offered will meet the known and anticipated needs of yourself and your family.

Our scheme at KeyHealth offers a range of products that falls within the budgets of most employees, yet is sufficiently comprehensive to satisfy their needs.