NHI Green paper – what does this mean for the member belonging to a private medical scheme now or who wants to enrol?

The NHI Green paper was submitted during August. In essence it is a document published for public opinion. Exactly how much it is going to cost, how it is really going to be funded, and when it is going to be implemented are all just estimates.

Marcel du Toit, CEO of Optivest Health Services, an independent healthcare consultancy, says: “Till the time the green paper “changes colour”, one must not forget that people out there who want to belong to a private medical scheme still need to be assisted with best advice”.

The NHI pilot projects will be implemented over the next five years and expanded over the next 15 years. The working relationship between public and private facilities and services needs to be addressed, and as stated by die green paper that will be part of Phase 2 of the implementation of the system.

During this time and even after the full implementation of the NHI system, members will still want to make use of services and benefits offered via the private healthcare sector. Du Toit strongly advices members to use their common sense when it comes to cover provided by medical schemes. Do not cancel your medical scheme membership now because you think NHI is around the corner and will provide all the healthcare cover required.

The idea of a national health insurance system and making basic healthcare available to all South Africans is long overdue and much needed, says Du Toit. There are more than 50 million South Africans, with only between 8 and 9 million lives covered by private medical schemes.

Affordability has been and will always be a major factor for members choosing or cancelling membership of their medical scheme. Du Toit advices members to evaluate their current level of cover and health conditions before cancelling their membership. Maybe your family is young and healthy, but you currently have comprehensive cover and can no longer afford it. Rather opt for a basic hospital plan, which is much cheaper, but at least you will still have some form of cover in the event of an accident or hospitalisation. Always keep in mind that any type of cover you choose will have co-payments, exclusions and so forth – do your homework beforehand.

Du Toit says if members want to make use of a broker when choosing a medical scheme, or just change from one option to another within their existing medical scheme, the broker needs to offer the member a financial analysis of the specific medical scheme and available options. Furthermore, he should at least provide the client with a comparison of 4-5 different medical schemes. Advice should be provided according to the specific needs of the client, taking into consideration the current health condition and financial position of the client. Before advice is obtained, it is also important to enquire whether the broker is independent and can provide objective best advice and support services to you.

During the months of September and October medical schemes will announce increases, new options available and changes to current options, so contact your financial adviser to make an informed decision regarding the benefits offered by the scheme and your choice of cover. Till the NHI is up and running, 25 different open medical schemes are available to members to choose from − do so wisely, says Du Toit.

Sake 24: 30 October 2011

© Healthesolutions (PTY) Ltd 2010 - All rights reserved | Privacy Policy | nedoweb