dyton mupawaenda
Emmanuel Kafe
CIMAS Medical Aid Society has said the recent adjustment of its United States dollar premiums was meant to maintain the buying power of its products and facilitate timeous settlement of claims to service providers.
The adjustment has caused an uproar among its members, who feel hard done by the medical aid society.
Policyholders said monthly subscriptions ballooned from US$179 to more than US$300 on one of the company’s packages.
Responding to the outcry, Cimas said the global threshold for a healthy fund requires medical aid societies to spend at least 80 percent of contributions on claims and quality improvement efforts, leaving the remaining 20 percent for administrative expenses and statutory reserves.
Cimas managing director Ms Tinotenda Mushapaidze said the adjustment was necessary.
“Of late, we have witnessed claim ratios breaching 105 percent and utilisation nearing 40 percent,” she said.
“That is to say 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.
“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.”
Ms Mushapaidze said some of the members were “wasting and abusing” the services through over-prescription of medicines, 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 US dollar 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,” she added.
One of the members of the medical aid society (name withheld) on the Secure Essential package said he was shocked to learn that the medical aid service provider was demanding US$300 monthly from June 20.
“Hard currency is not affected by inflation like the local currency, and how do they just increase the fees without engaging policyholders?
“I was shocked when they required me to pay such a huge amount; worse still, they refused to have a proper dialogue with us. We feel this is unfair on the part of the members who pay subscriptions.”
Secure Essential is one of the entry-level Nostro packages offered by Cimas, which gives a member access to private hospitals.
The package targets middle-tier managers.
This category covers private hospital access up to Group A hospitals.
Another member (name withheld) said the hike was unbearable and that there is need for dialogue to review the medical fee.
“Despite such a considerable hike, we should have been addressed and given reasons for that increase.
“They kept on referring us to the call centre team. The management is refusing to address our issue,” she said.
Online Reporter