MEDICAL aid companies are in the eye of a storm as policyholders are accusing them of ripping them off through drastic increases in contributions, most of which are wiping out their salaries.
Despite the steep reviews, some doctors and service providers continue to reject medical insurance. A Bindura University of Science Education lecturer Richard Masinire has since approached the courts to seek legal redress after his basic salary ($20 000) was wiped out by Premier Service Medical Aid Society (PSMAS). Masinire is claiming US$10 000 in damages.
Our Harare Bureau interviewed a policyholder whose medical aid subscriptions, which cover three family members, ballooned to $11 000 in September.
“Medical aid contributions have increased rapidly, but the problem is that most service providers like eye specialists are not accepting medical aid,” said the policyholder, who spoke on condition of anonymity for professional reasons.
“Service providers are demanding cash in United States dollars, meaning medical aid has suddenly become useless as an insurance for an ordinary worker. Some service providers say pay cash and then claim from the medical insurer for reimbursement. It is no longer an insurance. It is a tragedy for the ordinary person.”
Questions over the justification of the sharp increases in medical aid have been raised, especially at a time when the official foreign exchange rate is fairly stable at $81,3: US$1. Association of Healthcare Funders of Zimbabwe (AHFoZ) chief executive officer Ms Shylet Sanyanga, however, said the increases were meant to lessen the burden for patients.
“Currently, most healthcare service providers are either charging in United States dollars (USD) or benchmarking their fees in USD and converting at the parallel market rate. This has been causing huge shortfalls and inconveniences for patients seeking healthcare services. It should be noted that the only source of income for medical aid societies to fund claims is member contributions, hence the need for the review of the contributions at intervals. There has been a mismatch whereby member contributions have remained predominantly in Zimbabwe dollars (RTGS) while healthcare services are pegged in USD.”
She claimed that there were several service providers who were accepting medical aid cards.
PSMAS public relations officer Ms Tsitsi Chawatama said the fees were tracking inflation as service providers were pegging fees to the USD. PSMAS provides medical cover for most civil servants.
“From October 2018 to date, the increase is now in the range of 2 000 percent. Ordinarily, subscriptions inform benefits, and if benefits are not reviewed while medical tariffs continue to increase, this results in huge shortfalls for the members. Subscriptions are regularly reviewed in a bid to track medical inflation and reduce or eliminate shortfalls. Options are available for members who cannot afford the current subscriptions. These include paying old rates with reduced benefits. And, in most cases, those members will incur huge shortfalls as their benefits cannot match the healthcare provider charges. Most medical aid societies work with service provider networks on agreed terms and conditions. One of the reasons why subscriptions were adjusted was to ensure that this network is serviced adequately. Medical aid is a three-part process, consisting of the member, the funder and the service provider, and of these three, the funder has the obligation to ensure that the member and the service provider both get service satisfaction.”
It is believed that putting medical aid providers under the supervision of the Insurance and Pensions Commission (IPEC) would help to regulate the sector’s operations. Currently, the industry falls under the oversight of the Ministry of Health and Child Care.
“We are still waiting for Government to do the necessary legal changes to bring them under our regulation,” IPEC spokesman Mr Lloyd Gumbo said.
Repeated efforts to get a comment from Zimbabwe Medical Association (ZiMA) secretary-general Dr Bismark Mateveke were fruitless.
Funeral insurance policies have also shot up, leaving policy holders with little money to take home from their salaries.