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and escalating costs of medical services.
It also emerged that some clients were conniving with medical practitioners to make double claims on people not covered by the schemes.
Investigations by The Herald showed that some health institutions had suspended cover to members of medical aid societies that defaulted on payments.
These medical insurances fail to settle payment to service providers within the 60- day window period.
Some medical aid societies said the mismatch between their tariffs and medical costs made it difficult for them to provide adequate cover to their clients.
Medical aid societies negotiate tariffs under the banner of Association of Health Care Funders of Zimbabwe (AHFoZ), while most medical service providers negotiate tariffs under the Zimbabwe Medical Association (ZIMA).
“There are no harmonised tariffs between AHFoZ and ZIMA and as a result there is no match between what medical services providers charge and what medical aid rewards. Consequently, members are asked to pay the difference,” said an administrator of a company-run medical insurance who declined to be named on Wednesday.
“Another issue is that of skyrocketing costs of medical services. When the multi-currency system was introduced, doctors were paid US$15 but now they are demanding not less than US$35 and this explains why most medical aid premiums have risen.”
Anaesthestists, orthopaedics, neurologists and physicians are among specialists accused of demanding cash upfront from patients with valid medical aid cards.
Costs of their services range between US$70 and US$700 per visit, amounts that are beyond what most medical aid societies in Zimbabwe reward.
However, other specialists such as ophthalmologist, physiotherapists, gynaecologist, charge between US$50 and US$60 while dentists are still charging US$20. AHFoZ chairperson Mr Enock Chitekedza confirmed that the costs of healthcare services in Zimbabwe were higher than the region and claims costs were also surpassing subscriptions collected.
“Ideal subscription levels are not affordable, however, funders are still giving competitive benefits to members. Subscriptions in Zimbabwe are lower than those in the region. Funders are currently attempting to gradually increase subscriptions to viable levels,” Mr Chitekedza said.
He said due to the liquidity crisis in the country, subscribers were taking long to pay their subscriptions thereby affecting the ability to meet claims on time.
He added that negotiations with Service Provider Associations were progressing well and agreed fees were being implemented in concluded cases.
Mr Chitekedza said each medical aid was compelled under the statutory requirements to maintain at least three months’ reserves to cover its members.
“However, it should be noted that the country is coming from a Zimbabwe dollar era where reserves were wiped out and funders are now rebuilding the reserves,” he said.
AHFoZ members, he said, were encouraged to pay within 30 days from date of receipt of claims.
“Thirty days turnaround is believed to be fair in a non-inflationary environment and is administratively practical,” he added.
The organisation also urged its members to invest in online card verification systems to speed up verification and pre-authorisations and ensure that service providers are protected from the risk of rendering services to non-members.
Another official noted that most companies were not only failing to remit medical aid premiums but were also failing to submit other statutory requirements such as the National Social Security Authority and Pension Funds owing to the liquidity crunch on the market.
He said medical aid societies should be allowed to raise their premiums to match what was demanded by medical services providers.
An official at one medical aid society said most medical aid societies have no monetary reserves owing to diminished revenue coming as a result of a surge in claims as more people on medical aid seek medical services.
“Some of the members cheat and they use the schemes to treat their relatives,” said the official.
The absence of reserves due to low subscription by members, have left medical aid societies heavily exposed should a disaster occur.
CIMAS demands US$45 for comprehensive cover for a family of six, meaning they enjoy all specialists services in private clinics in Zimbabwe. Some company company run medical aid scheme demand an average US$ 53 for a family of five, while the company contributes US$ 67. PSMAS needs US$10 per member for full cover and this medical insurance has its own hospitals, pharmacies and doctors. However, it covers mainly civil servants and their subsidised facilities cannot be accessed by outsiders.
Investigations by the Herald, however, revealed that most private companies managed medical aid schemes were suffering because the management delayed in remitting workers contributions.
“It is very important for a medical aid to have reserves which they would use as a fall back should a disaster of a high magnitude occur at a firm, for example. Reserves secure members against any eventuality, they would then liquidate their reserves to offset the claims arising from an accident of high magnitude,” he said.
Online Reporter