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Health Insurance -
There have been many heated debates (and meetings) during the past years between the Council for Medical Schemes, the FSB, SAIA and the LOA (ASISA) as to who controls the insuring of health risk.
This decision has finally been escalated to National Treasury for consultation and clarity on which healthcare risks may be undertaken by which financial services sector (and then came NHI!!). National Treasury and the various financial sectors have begun a process of supplying data to National Treasury, in order that clear regulations may be drafted into the Insurance Laws Amendment Act No 27 of 2008. The initial attempt at this Act was rejected and opposed by the insurance industry as unworkable.
Upon the finalisation of such regulations, which shall be as a result of the recommendations of a work group comprising of the FSB, ASISA, SAIA, CMS, Dept of Health, the Treatment Action Campaign and the Aids Law Project, it is expected that a working solution shall be inducted into the Insurance Laws Amendment Act.
How this shall comply or fit in with NHI is yet to be discussed. Therefore, as it stands, the existing Insurance Act stands, and accordingly health insurance may be written, which conforms to such Act. This would include Gap cover (as challenged by CMS via legal avenues and the Constitutional Court), stated benefit health policies, hospital cash plans, dread disease, medical travel cover and such similar type products.
The most recent types of health cover to be introduced to the market are those offering cover for injuries incurred as a result of a motor vehicle accident. These have been introduced by insurers as a necessity, given that the government run Road Accident Fund Scheme is offering totally inadequate (and inefficient) benefits. These products typically offer disability (temporary and permanent) cover, as well as accidental medical expenses. This is because the RAF restricts benefits for both these occurrences to R166 000 p.a. (and they are subject only to “major injuries”). The authorities involved in these new restrictions have indicated (in the press) that it is recommended that members of the public (our clients) purchase private insurance to cover these “shortfalls”.
I have no doubt that these types of products will, at some point, come into the demarcation debate – or need to be addressed in the Insurance Laws Amendment Act. It appears as the Demarcation issues are being addressed, that the National Health Insurance concept is to be introduced. If and when, the NHI, is introduced, the entire “playing field” for Medical Schemes as well as Insurers will change. There is a debate as to whether Medical Aid Schemes will have to register as Insurers, how the Medical Schemes Act will need to be changed, How the Insurance Laws Amendment Act will again need to be changed.
Will Insurers or Medical Aid Schemes offer “top-
All these aspects, are for the present unknown – but they will affect all of us – buyers of health insurance, or marketers of health insurance!