Medical aid co-payments deemed ‘irregular’
No more penalty co-payments will be allowed for medical schemes after the Council for Medical Schemes (CMS) declared this practice irregular and undesirable in terms of the Medical Schemes Act in a notice in the Government Gazette, reported The Citizen (5 May 2021).
“The registrar decided to - subject to written representations by interested people and with the concurrence of the CMS and the Minister of Health - declare these co-payments which exceeded the difference between the amounts charged by service providers as undesirable. This also includes any other co-payments which are unfair to members or beneficiaries, or cannot otherwise be numerically justified. The CMS believes the practice of using DSPs has prevented many healthcare service providers, including independent community pharmacies, from joining the DSP network although they are willing and able to provide healthcare services at the same fee rate. The CMS also declared the practices of some medical aid schemes to select designated healthcare providers as irregular.”