There is no national medical insurance scheme in South Africa.
Private medical schemes, regulated by the Medical Schemes
Act, offer group membership or individual cover. Contributions to group
schemes are usually split between the employer and employee. Medical aid costs
are rapidly rising, partly because of the increase in the price of drugs, medical
equipment and doctors' fees. The government wants to introduce a social insurance
policy requiring all employees to have health insurance. Medical schemes, fearing
that an influx of low-income earners into their schemes will place an enormous
financial burden on them, are lobbying for a subsidised national health scheme
instead.
Most medical schemes provide a variety of choices for the consumer - from a
basic hospital plan to full medical cover. Belonging to a medical aid is becoming
increasingly costly and members often have to pay additional expenses. Doctors
bills and some private hospital costs often exceed the scale of benefits, or
the amount that the medical aid is prepared pay. Medical aids also place ceilings
on various categories of medical expenses - for example, R5,000 per year for
dentistry for the family - and if these are exceeded, the member is liable for
payment. Some medical aids, like Discovery Health,
are encouraging their members to follow healthy lifestyles with a point system
that rewards them with benefits for regular exercise, medical check-ups and
other practices that reduce illness.
With 43 hospitals and 18 day clinics around the country, Netcare
is the biggest private health provider in the country, and offers many specialist
services. A total of 2,900 medical professionals are associated with the health
care group. Netcare's web
site provides a doctor search (of doctors in the group), as well as information
about specific
hospitals. Detailed information and photographs are supplied on each hospital,
as well as lists of services offered, a doctor search, and hospital and doctor
contact details. Another major private health company is the Medi-clinic
group. which runs 35 hospitals around the country. A map on its website
provides area-by-area details of each of the hospitals and the services they
offer.
The Short-term Insurance Ombudsman Ombudsman
for Short-term Insurance Association investigates complaints from the
public against short-term insurers that are members of the Ombudsman for Short-term
Insurance Association. You must first complain to the insurer or broker concerned.
The ombudsman usually holds an open house on Wednesday mornings for quick advice
sessions at Promat Centre, 5th Floor, 27 Stiemens Street,
Braamfontein. Tel: (011) 726 8900 Fax: (011) 726 5501.
Short Term Insurance Ombudsman Links:
The Long-term Insurance Ombudsman investigates
complaints from the public against life and long-term insurers that participate
in the Ombudsman's Scheme. The consumer should
try to resolve disputes with the insurer before consulting with the Ombudsman.Tel:
(021) 674 0330 Fax: (021) 674 0951.
Long Term Insurance Ombudsman Links:
For a list of links to all medical schemes registered with the Board
of Healthcare Funders (BHF), their representative
organisation, go to BHF
Global or tel: (011) 880 8900. The BHF will also deal with all complaints
relating to medical aid malpractice. The Financial
Services Board is an independent statutory body that oversees the non-banking
financial services industry - including insurers, retirement funds, unit trust
schemes, and financial markets - and handles complaints in the public interest.
However, you should only contact the Board if you feel that the law has been
transgressed or is inadequate.
- Tel: (012) 428 8000
- Toll-free: 0800 110 443 / 0800 202 087
- Fax: (012) 347 0221
- E-mail
- Web site (click on "online
complaint" to file a complaint electronically)
Useful Addresses
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