Govt Medical Aid Not That Great
I READ with great interest the article on The Namibian’s front page of Monday, October 15, concerning public servants paying more for medical aid.While I admit that the monthly amount paid for medical cover through PSEMAS [Public Service Medical Aid Scheme] is small, this needs to be put into perspective in comparison with what service is provided.
But before expanding on that issue, let me please make an appeal to the Ministry of Finance to exempt pensioners from the increased contributions!I believe that non-civil-servants think that the government medical aid scheme (PSEMAS) is dirt cheap, but unfortunately, several factors have caused medical costs to become a real burden to public servants and especially pensioners. Firstly, many medical practitioners have opted out of the scheme, forcing public servants and pensioners to pay full costs up front to the doctor/specialist/dentist/pharmacy/hospital, before submitting a claim to PSEMAS. With consultations and even basic services costing hundreds of dollars, this is an enormous problem for many.
Secondly, the tariffs charged by the medical fraternity, and the tariffs on which claims are calculated at PSEMAS, are now totally unrealistic. When I submit a claim to PSEMAS, I no longer even expect to get half of my expenses back! A few examples from a recent dentist visit highlight these discrepancies
Item code 8338 - N$1950 charged by dentist, N$545 is the tariff used by PSEMAS; Item code 8329 - N$650 charged by dentist; N$181 is the tariff used by PSEMAS; Item code 8376 - N$1400 charged by dentist; N$427 is the tariff used by PSEMAS...
To make matters worse, it seems that PSEMAS staff reject parts of claims for no valid reason! Several items on my last claim were disqualified, with a ‘Reject Code’ 153, which apparently means ‘Requires receipt or proof of payment’. However, when confronted at the PSEMAS offices, the officials had to acknowledge that proof of payment was indeed attached and submitted!I earnestly encourage every public servant and pensioner to closely examine all PSEMAS claims returned, and to challenge any items they feel have been wrongly rejected, as the PSEMAS office obviously makes mistakes.But back to the issue of tariffs charged versus tariffs paid out by PSEMAS.
The newspaper article states (correctly I believe) that the PSEMAS tariffs used have not been amended for about four years! No wonder the pay-back to members is now a tiny fraction of what they are actually paying for medical services! It might even be worth paying some thousands per month for private medical cover if PSEMAS are only paying back peanuts? On behalf of public servants and especially pensioners, I eagerly await news that PSEMAS has finally brought its tariff scales back to realistic levels commensurate with what patients are being charged.
Alan Hattle Chairman, Khomas Branch National Association of Namibian Pensioners