Fedhealth welcome proposed amendments to Regulation 8

Fedhealth has come out in support of Health Minister Aaron Motsoaledi’s proposed review of Regulation 8 of the Medical Schemes Act agreeing that the current PMB legislation is just not sustainable.


Fedhealth Chairman Jeremy Yatt said the full invoice price for PMB conditions has been a contentious issue for a number of years due to certain providers abusing the relevant sections of the legislation. “The unintended consequences on the system have been far reaching. Since PMB legislation was implemented, the increase in scheme costs has been significantly greater than the increase in medical inflation and the proposed review will finally provide much needed clarity on the reimbursement rate.


Not only will the review protect medical schemes from open-ended liability for prescribed minimum benefit conditions claims, but it  will ultimately provide a far better solution for the industry, and more importantly, for members. We have for example encountered many instances where certain providers have charged significantly more for a PMB consultation than for a non-PMB consultation,” he says.


To date certain healthcare providers have abused the system and this has pushed up the cost of private healthcare and impacted negatively on consumers who ultimately bear the brunt of inflated prices through higher annual benefit increases.


Fedhealth do not believe that providers or members need necessarily be adversely affected by the result of the proposed review.


The contracted rate that Fedhealth pays to its network specialists is already higher than the fees set out in the proposals. “As a scheme we have negotiated higher tariffs with healthcare providers to protect members from co-payments. More than 7 500 healthcare providers have already contracted with Fedhealth and are happy with the agreed rates. We don’t understand why other healthcare providers need to charge so much more,” says Yatt.


And it’s not only Fedhealth that has provider networks. Most private schemes already have DSP networks in place with their providers.


“We will now have clarity on the question of “cost” which has been a problem for many years. We accept that doctors can charge whatever they want,  however they cannot expect to be reimbursed by medical schemes at an uncapped rate. We also believe that members must continue to have the choice of either selecting a network healthcare provider for their treatment who will be reimbursed in full for their PMB treatment, or alternatively, electing to go to a non-network healthcare provider and agreeing to fund any shortfall that may be incurred,” concludes Yatt.