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Monday, 11 February 2013

Medical Aid Schemes.

In my previous post I mentioned Medical Aid Funds, Pumice from asked me to explain the system. Medical Aid Schemes started, I would imagine, around the first half of the 20th century here in South Africa. (I must point out that I'm not an expert at Medical Aid schemes, so some of my info might not be 100% correct, but I think I've covered the basics).

When I started working for the Post Office, in 1965, I joined the Post Office Medical Aid. This scheme was started and administered by Post Office staff. I think other Government Departments had similar schemes in place. Till recently my medical aid was called Telemed, (an offshoot of the old PO Medical Aid Scheme) now defunct and taken over by a private insurance company. My Medical Aid cover, which is very comprehensive, costs about R5000 per month for two people, about $600 US. Fortunately this is considered part of my pension so it cost me nothing. All Government employees who retire with more than 15 years service, are covered by Medical Aid. If I was still working for the Post Office they would be paying half of the R5000.

Apart  from GEMS, (Government Employees Medical Scheme) I would imagine that most Medical Aids are now run as profit making businesses. The company you work for usually approaches one of these Medical Aid Schemes and asks them to cover their workers. Schemes have several options, from the most basic cover, to very extensive. The employee chooses one and signs up. Employers often cover part of the cost, usually Rand for Rand, in the US it would be $ for $. Payments for Medical Aid cover is tax deductible, not 100%, but a very large portion.

The Medical Aid council determines how much will be paid for each medical procedure, consultation, etc. Doctors can opt in to these fees or opt out. If you should visit a Dr that has opted out of the system you have to pay him direct and claim from your Medical Aid afterwards. Doctors that have opted in claim directly from your medical aid. Prescription medication is also covered, as is X rays, etc.

Also available are reasonably priced Gap covers, which covers any shortfall if you were hospitalised or had an operation. There are other "insurances" such as Dread disease cover, for cancer and other chronic illnesses, these are not very expensive. This kind of insurance does not cover existing illnesses you might have. You need to have the insurance before you get cancer, or diabetes, etc.

Medical Aid Schemes are governed by very strict laws, and to stay in business have to prove that they have enough funds to cover any medical claims.

Our government is also talking about setting up a "National Health" system, where every one will be guaranteed minimum health services. I think the emphasis will be on the minimum. Fortunately most time estimates point to this coming about in about 2037. By then I should have gone to my just reward.


Gorges Smythe said...

Most government plans are, at first, well intentioned. Then reality and corruption set in.

Pumice said...

Thanks for the response. The system seems to give a good deal of choice to the individual. I am sure it has it flaws but it would do for our politicians to look at what you have now.

I would not look forward to them making it a national system.

Grace and peace.

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