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There are approximately 3.9 million people who are fortunate enough to belong to a medical scheme in South Africa. Very few of these people will likely deny that a medical scheme membership plays a significant role in ensuring some form of peace of mind when it comes to contemplating the worry of not having access to private healthcare facilities. The cost of membership of a medical scheme is rising faster than inflation and the picture for 2015 looks no different to that of previous years.
The reason that the Council for Medical Schemes (CMS) has pushed the demarcation issue so vehemently is the assumption that gap cover undermines the existence of medical schemes.
The South African healthcare industry is currently undergoing significant changes while the Department of Health builds towards clarity and the implementation of the long awaited National Health Insurance programme.
When prescribed minimum benefits (PMB) were introduced as law into the medical scheme environment, they introduced a new methodology as to how costs were to be managed. Schemes set about setting up preferred provider networks known as Designated Service Providers (DSP) as well as the processes required by members in order for defined PMBs to be covered.
The big-picture theme causing you and your clients the greatest concern is: