Confusion over PSEMAS private hospital cover

Members of the state medical aid fund, PSEMAS, are being asked to join a new private hospital scheme to cover them against the deficiencies of state hospitals, but the scheme is not operational and there are questions about its ability to cover the entire cost of a procedure in a private hospital.
About 100,000 members have to be registered in the new scheme and verification protocols for private hospitals to check if patients are eligible for the scheme are not yet in place. The uncertainty is being discussed by medical professionals who are unsure how to proceed or how to claim if public servants want to be admitted to private hospitals under the scheme.
According to Sister Lynn de Vos of Grootfontein Private Hospital, “We have not received any information on the scheme so we do not know how to handle patients.”
Speaking on behalf of the Medical Association of Namibia, Dr David Weber said, “There is still confusion in the private medical industry concerning the PSEMAS private hospital benefit, and clear protocols for payment and verification have yet to be put in place. We expect further clarification from the Ministry of Finance in the immediate future.”
Dr Weber’s advice to PSEMAS members is not to cancel supplementary private hospital gap plans until full insight is gained into the upgraded PSEMAS system.
Financial details of the scheme also show that it will place a financial burden on patients. The new scheme promises to pay 95% percent of 2010 NAMAF tariffs, however these are not current 2013 NAMAF tariffs, and are not binding on medical professionals.
Private hospitals will also require the 5% member contribution plus the difference between cover and actual cost, to be paid upfront before admission.
Costing for a major procedure illustrates the extent of the threat to the financial well-being of individuals. The Roman Catholic Hospital estimates the cost of hospitalisation and surgical facilities for a heart bypass at N$250,000. A call to a local medical aid company placed the cost of a cardiovascular surgeon at N$20,000 and an anaesthetist at N$10,000, for an estimated total of N$280,000. These rates are not NAMAF rates.
Johan Struwig, Director of Development for Prosperity Group said “Being hospitalised can be a stressful experience that often leads to excessive medical costs. The most important consideration for PSEMAS members is to ensure that their hospitalisation is covered at 100% of the actual cost. Even a small percentage co-payment on your hospital bill can result in a huge financial burden.”