No cash upfront for medical aid card holders

Source: No cash upfront for medical aid card holders | The Sunday Mail June 5, 2016

Shamiso Yikoniko
Health Reporter
MEDICAL aid card holders will not be required to pay cash upfront come July 1, 2016; Health and Child Care Deputy Minister, Dr Aldrin Musiiwa has said.
The deputy minister said medical insurers who fail to remit claims to service providers by June 30 will lose their licences.
“We will not allow that to happen. There is no way subscribers will lose cover.
“The medical aid industry is required by law to pay claims within 60 days of them receiving claims from service providers. Medical doctors, on the other hand, aren’t required by law to ask for cash upfront before offering a service.”
The majority of medical aid societies were issued with temporary operating licenses expiring on June 30 because they were failing to remit claims to service providers within the expected 60-day period.
Medical aid societies are regulated by the Ministry of Health and Child Care under the Medical Services Act.
Among other things, the ministry monitors medical aid societies’ activities, including the execution of their fiduciary responsibility and their financial performance.
Dr Musiiwa added: “In some instances, we will be forced to place interim management.”
Zimbabwe has 31 medical aid societies and there are currently 1, 2 million people on medical insurance.
Zimbabwe Medical Association (Zima) announced that from July 1, patients will be required to pay cash up front and claim reimbursements from their respective medical aid societies.
Zima argues that doctors are paying tax to Zimra for claims not yet settled by medical aid societies. The association says it is owed US$220 million by medical aid societies.
Zima secretary-general, Dr Shingi Bopoto, said non-remittance of claims is benefiting the health insurance companies while disadvantaging patients and service providers.
“The law says no doctor shall turn away a member who is holding a valid medical aid card but is that card valid when the so called medical aid isn’t paying claims? At the end of the day, the patient and the doctor are the ones being disadvantaged,” he said.
“It hasn’t been easy to arrive at that decision but we feel we have tried everything like going to the regulator, parliament and other relevant statutory bodies but the situation on the ground seem not to have changed and at the end of the day as doctors and other health care providers, we are faced with the taxpayer on monies that they haven’t received.”
But Association for Health Care Funders of Zimbabwe (AHFoZ) chief executive officer, Mrs Shylet Sanyanga said, “It’s not a fact that medical aid societies are not paying service providers timeously. They are paying but in cycles within at least 60 days.
“Because of the economy in which all businesses are operating, some employer organisations are not able to remit subscriptions on time to the medical aid societies.
“Since dollarisation, most medical aid societies have not been able to build reserves. Some payment plans are not being observed. The problem is bigger than just the medical aid societies, it’s at a macro economical level.”