Medical aid schemes complain that specialist doctors are sucking them dry — and government regulation blocks them from doing anything about it.
Prescribed minimum benefits covering 271 life-threatening conditions and 26 chronic illnesses are the biggest cost driver for medical aid schemes.to personal finance journalist and educator Maya Fisher-French.However, the problem is not necessarily the range of care medical schemes must provide at cost, but specialist doctors that take advantage of the PMB regulations.
This sets a floor for the cheapest medical aid plan in South Africa — they must charge at least R866.02 to cover the average cost of PMBs.Prescribed minimum benefits expenditure by age band for 2019 and 2020 — Council for Medical Schemes Basic hospital plans start at R1,500–R2,000 per month for the main member, increasing to around R2,300 per month for a single parent with a child.However, the credit can only be claimed at the end of a tax year, andAlthough an advisory committee at the council is working on how schemes could provide low-cost benefit options, including considering a reduced set of PMBs, this has been ongoing for years.
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