The DILEMMA

One of the most complex areas of the healthcare system for Medical Scheme members and healthcare providers is the increased range of rates charged by providers. Since 2004 there has been no “medical aid rate” or “private rate”. Complimed has seen an increasing divergence across the industry of non-standardised rates. This disparity in rates leads to a great deal of confusion for members and greatly increases their chances of additional out-of-pocket payments. This dilemma is caused, in the main, by providers charging in excess of the benefits on the member’s plan choice.

There is also the propensity for schemes to add co-payments to frequently occurring procedures.

The SOLUTION

Either upgrade the option within the Medical scheme, at a significant increase in premium (15 – 20% in most cases).

OR

Self - insure through CompliMed, who has recognised this potential shortfall and created its range of GAP products to cover these payment shortfalls and co-payments.

All these products are defined as an “accident and health policy” under the Short-Term Insurance Act No 53 of 1998.