Health insurer Discovery has published its full price adjustment schedule for medical aid members in 2020, showing a 9% to 11% increase across its plans.

Discovery Health Medical Scheme is the largest open medical scheme in South Africa, covering nearly 2.8 million beneficiaries, with an open medical scheme market share of approximately 56%.

Due to the increased cost of providing healthcare in South Africa, the medical aid industry typically hikes fees at a rate of CPI + 4%. With CPI currently sitting at 4.0%, this would put the industry average at around 8% for 2020.

Stats SA will release new inflation data on Wednesday (18 September).

Discovery’s price hikes come at a time of uncertainty for the medical industry, with the passing of the National Health Insurance (NHI) Bill last month adding to some anxiety in the private healthcare sector.

While the bill makes provision for medical aids to remain in South Africa, the wording of the piece of legislation is ambiguous in their role.

Under the NHI, medical aids will have a significantly reduced role in the country’s healthcare, providing ‘complementary’ or ‘top-up’ coverage for services that are not covered by the NHI.

The NHI director-general previously stated that this is because it would be inappropriate for the state to legitimise buying cover for services that are already covered by the NHI.

Government has made it clear that the R280 billion spent on private healthcare should be added to the pool of R230 billion spent by government on public healthcare, leaving many wondering where private companies like Discovery, Momentum and Netcare will fit in.

Discovery’s take on the bill has been optimistic, with its reading of the bill taking it to mean that medical aids will be available as an option to those who do not go the route of using the NHI’s services.

“The NHI Bill makes the point that this ‘complementary role’ for medical schemes will only apply once the NHI is ‘fully implemented’ and that it defines ‘referral pathways’ to which it will apply, indicating that where patients choose not to follow the referral pathways, the NHI will not reimburse their care, and that they can then claim from private health insurance,” Discovery said.

“These elements of the NHI Bill all speak to a continued and important role for medical schemes, and we will engage actively and constructively to make these points and to ensure an ongoing critical role for medical schemes and for private healthcare providers as the process goes forward.”

The group has called for clarity on where exactly medical aids fit into the scheme.

 

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