adminRejoice Makoni Herald Correspondent
Cimas Medical Aid members have raised concerns over the recent hikes in their contributions by more than 100 percent despite the fact that they are pegged in United States Dollars.
Receipts shown to The Herald reporter by some Cimas members revealed that their premiums jumped from $148 in May to $304 in June.
A Cimas member who requested anonymity said she was devasted by how Cimas was short-changing them.
“I paid more than US$300 today for my medical contributions and I am worried about the rate these contributions are hiked as we may end up paying more than US$500.Almost all my monthly earnings went towards medical aid contribution and I hope they are going to revise them downwards” she said.
However, in an interview, Cimas Group Marketing Officer Bhekimpilo Ntini said the increase only affected members with adverse claim ratios.
“We have witnessed claim ratios breaching 105% and utilisation nearing 40%. That is to say that there are a few members of the society whose utilisation of the fund is way too high and is not in sync with their monthly contributions. As a result, contribution rates were revised for these members with adverse claim ratios” he said.
“This means for these members, the Society was consistently paying more than it received, thus being a drain on the fund and jeopardising care for the other members. Some of these members already have ratios exceeding 40 times their contributions.
We have also noticed that in some cases, there are indications of waste and abuse through overprescription of medicines, seemingly unrelated lab tests, numerous doctor visits for minor conditions and other activities, which have become a huge drain on the fund.
“As a consequence, the society has been forced to review contributions for the USD packages for the most affected categories of members (high utilisers, high claim ratios) to maintain the buying power of the Cimas card and to ensure timeous settlement of claims without punishing those members whose accounts are performing within the acceptable thresholds”
Ntini also said service partners are responsible for claiming only for rendered care, requesting only necessary lab tests, prescribing generics instead of branded medicines and avoiding unnecessary procedures.
Online Reporter