MEDICAL AID OVERVIEW
20 15 A
SUPPLEMENT
O’DONOGHUE & ASSOCIATES 33962a
CLEAN UP
Sick days can cost you and your Company. Wash your hands regularly and keep the work force healthy. ISN'T PREVENTION ALWAYS BETTER THAN CURE?
As a TopMed Medical Scheme client, our registered nurses not only know you and your employees’ medical history, they're qualified to help them make the lifestyle choices they need to improve their health.
Call: 0860 00 21 58 or visit www.topmed.co.za
Your Plan For A Healthier Life.
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O’DONOGHUE & ASSOCIATES 33962a
MEDICAL AID OVERVIEW
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SUPPLEMENT
Opinions expressed in this publication are those of the authors and do not necessarily reflect those of the Publisher, Cosa Communications (Pty) Ltd, COSA Media, and or RiskSa (Pty) Ltd. The mention of specific products in articles or advertisements does not imply that they are endorsed or recommended by this journal or its publishers in preference to others of a similar nature, which are not mentioned or advertised. While every effort is made to ensure accuracy of editorial content, the publishers do not accept responsibility for omissions, errors or any consequences that may arise therefrom. Reliance on any information contained in this publication is at your own risk. The publishers make no representations or warranties, express or implied, as to the correctness or suitability of the information contained and/or the products advertised in this publication. The publishers shall not be liable for any damages or loss, howsoever arising, incurred by readers of this publication or any other person/s. The publishers disclaim all responsibility and liability for any damages, including pure economic loss and any consequential damages, resulting from the use of any service or product advertised in this publication. Readers of this publication indemnify and hold harmless the publishers of this magazine, its officers, employees and servants for any demand, action, application or other proceedings made by any third party and arising out of or in connection with the use of any services and/or pro-ducts or the reliance of any information contained in this publication. Copyright RISKSA (Pty) Ltd 2014. All rights reserved.
PO Box 60320, Table View, 7439 Tel: 021 555 3577 Fax: 086 618 3906 E-mail: info@comms.co.za
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Ground floor, Manhattan Tower Esplanade Road, Century City, 7441
MEDICAL in 2015 Christy van der Merwe
AL AID
The complicated healthcare landscape in South Africa makes it very difficult for straightforward price comparisons between schemes by end consumers and good advice is vital. RISKSA aims to bring you salient details from the top open medical schemes going into 2015 that brokers can share with clients.
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he majority of medical aid member contribution increases for 2015 were above the inflation rate set by the consumer price index (CPI), however, this was no great surprise as healthcare inflation was again higher than CPI-linked inflation, as it has been for almost a decade.
“Very few employees receive salary increases matching the increases experienced in medical aid. This means that people are now being forced to consider downgrading options, or if that is not possible, resigning from the scheme altogether,” says Robert Wilson from Dave Wilson and Associates Financial Services, highlighting the key issue for advisors.
“As financial advisors, all we can do is work with our clients to try and reduce their expenses without impacting too heavily on their long-term financial planning,” Wilson adds. In the Council for Medical Schemes (CMS) guidance for pricing in 2015, the regulator said: “Having considered year on year changes in
the CPI and other key economic indicators, the CMS advises that the cost increase assumptions of medical schemes for the 2015 benefit year should be limited to a maximum of six per cent for each individual cost driver.� The CMS reiterated that contribution increases are based on individual schemes experience, solvency level and risk profile, and the regulator is currently reviewing all the schemes increase submissions. Len Deacon and Associates CEO, Len Deacon, explains what factors impact these contribution increases every year: Inflation: healthcare inflation outstrips general inflation. Prescribed Minimum Benefits (PMBs): for most schemes, besides hospital costs, much of their healthcare expenditure is on PMBs, which must be covered in full, and schemes have very little control over. Fees are not regulated and increase at rates much higher than inflation.
Demographics: the overall age profile of medical schemes is increasing, as younger members tend not to join. Another regulatory issue that needs to be addressed is compulsory membership. Older members usually require more healthcare.
Capitation fees: the assumption is that capitation fee arrangements should contain costs better than where a fee-for-service arrangement exists. If these increase off a low base, this could have a negative impact on contributions for members.
Utilisation: increased utilisation due to the introduction of new expensive technologies, new drugs, or increased use of specialists impacts the cost of claims of a scheme. The burden of disease in the medical scheme population is also gradually increasing.
Non-health costs: mostly related to healthcare administration and risk management staffing – much of this staff complement is highly trained professionals who must be remunerated appropriately to be retained. In recent years, salary increases have been well in excess of inflation to avoid losing key staff to competitors.
Hospital costs: most medical schemes are price takers, they do not have significant bargaining power when negotiating hospital fees. Medicine costs: administered prices of medicines increased lower than inflation, however, schemes are compelled to make allowance in their contribution rates for possible future price hikes, or risk being underfunded if the expectation of a zero increase is not met.
Reserving: schemes are required to build and maintain reserves to ensure that members can rely on solvent medical schemes capable of paying their claims. This ratio is legislated at 25 per cent (accumulated funds divided by annual contributions) and must be maintained and taken into account in annual contribution increase calculations. In the current low inflation environment, investment returns cannot be relied upon to maintain the required solvency ratio.
In no particular at the order, here is wh mes he major open sc what t ou ab had to say pect ex n ca rs membe in 2015. Bonitas has a solvency ratio of 33.3 per cent with reserves of R3.3 billion, and the scheme says it pays out 93 per cent of all claims – more than any other open medical scheme.
BONITAS
7.2%
The average increase across options at Bonitas will be 7.2 per cent for 2015, ranging from a 5.7 per cent increase for the standard option, and 9.8 per cent on other options.
Bonitas reduced the co-payment for biological drugs by 10 per cent in an attempt to reduce all co-payments on the scheme, and depression has been added as a chronic benefit.
The scheme has undergone a rebranding exercise to attract new members, and also completed the merge with Pro Sano, which added some 23 495 members to the scheme.
On the wellness front, Bonitas entitles all members to one free health assessment a year and offers free flu vaccines and HIV tests on all options.
Weighing up the options Len Deacon and Associates CEO, Len Deacon, urges advisors and scheme members to do their homework to understand how benefits have been eroded and what the financial increases are. Check whether various limits and sub-limits have stayed the same or dropped because both of these actions are akin to a reduction in benefits. Once all the intricacies of various plans are known, it is a matter of choosing the best fit for your client.
DISCOVERY
FEDHEALTH
9.9%
10.6%
The increase for 2015 across all plans in the Discovery range will be 9.9 per cent, with the exception of the Executive option, which will increase by 10.9 per cent “to ensure its ongoing sustainability, whilst maintaining its competitive contribution relative to similar high-end options in the market,” says the company.
The overall average increase on the Fedhealth Maxima range is 10.6 per cent going into 2015, and Fedhealth says that the benefits structure remains largely unchanged. However, the scheme has switched the order of the funding of these benefits. Day-to-day benefits will now first be paid from current savings, and then from the out-of-hospitalexpenses-benefit (OHEB). An inflationary increase of six per cent will apply on all Maxima benefit limits, in particular the OHEB, savings and threshold levels.
The main focus of Discovery’s launch presentation was on enhanced wellness interventions and enhancements to the Vitality programme. Discovery Health said it would be one of the first health insurers globally to assist in funding of wearable health and fitness devices.
Maxima Saver, and Maxima EntrySaver members will also now get the unlimited GP benefit in 2015, thus getting unlimited access to a nominated network GP paid as a risk-benefit once their annual savings have been depleted. Fedhealth’s lower cost Blue Door option announced increases ranging from R151/m to R462/m. “In a measure of sustainability, minor benefit cuts were necessary to reduce claiming costs and align the option with comparable products in the market,” said the scheme. Hence, GP visits would remain unlimited, but now offered at a nominated contracted GP, and subject to protocols and utilisation monitoring after six visits per beneficiary. Specialised radiology is now offered in-hospital only, and chronic medication is subject to a revised formulary.
Also on the technological advances front, the scheme introduced ‘on call – virtual doctor consultations available to all members of the scheme and paid from the member’s available day-to-day benefits. Co-payments and deductibles increased in line with annual contribution increases while annual thresholds increased by 10.9 per cent for the comprehensive series, and in line with the annual contribution increase for all other options. The oncology threshold remained unchanged, and the internal prosthesis limit increased in line with surgical inflation.
Fedhealth also launched the ‘Wellculator’. A mobile app, the Wellculator is an interactive pre-diagnostic assessment tool that gives members an honest gauge of their current health status, and the opportunity to evaluate potential future risks, and make lifestyle changes accordingly.
The Discovery Vitality membership will cost R185/month for a single member, R219 for a member and one other person, or R249 for a member plus two other people.
Questions to ask your client when deciding on a plan.
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1 Did your lifestyle or life stage change in the last 12 months?
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What are your day-to -day out of hospital healthcare needs?
GENESIS
5.3%
The average contribution increase for 2015 for Genesis medical scheme will be 5.5 per cent, which the scheme is confident will be the lowest in the industry for the third consecutive year. An adult member on the scheme’s hospital plus dental benefit option will pay only R75 more per month in contributions while benefit limits increase noticeably. Discussing the relatively low contribution increases, Genesis executive, Brian Watson, said “The answer lies partly in the fact that bigger isn’t necessarily better as Genesis proves year after year. Some of the biggest schemes in the country have not attained the minimum level of solvency required by law. The benefits of self-administration, prudent risk management, having sufficient reserves to withstand almost any major disaster, together with a board of professional trustees
whose fees are among the lowest of all open schemes, are critical components in containing healthcare costs.” Watson added during the ‘good years’, Genesis steadily built up its reserves so that when times were tougher, the scheme could reward its loyal membership with lower contributions and higher healthcare funding benefits rather than other forms of loyalty rewards. Genesis members can choose their preferred hospital, doctor or medical specialist along with a choice of funding model. Members do not have to seek treatment in network hospitals or make use of network medical practitioners. Genesis does not, however, provide any healthcare service or treatment, and the scheme reimburses members’ claims in terms of its rules.
MOMENTUM
7.9%
The average contribution increase on Momentum’s options was 7.9 per cent, ranging from a 3.5 per cent increase on the Ingwe option to 10.8 per cent on the summit option. Momentum has a definite focus on putting the client at the centre of what the scheme does and allows clients to tailor options according to their individual needs and ability. With the option to pay HealthReturns into a HealthSaver account, members can increase or decrease their day to day funding as their needs change, without having to change their option.
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Are you comfortable with being restricted to a specific network of providers?
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Do you use ongoing medication for a chronic condition?
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There would be no co-payment increases for 2015, and the oncology limit has not been increased, however the mammogram benefit has been enhanced. Mammograms will be payable as part of HealthPlatform from age 38 (previously 40), and vasectomies are now also covered on Ingwe and Access options.With regard to the Multiply wellness and rewards programme, the price for a single member will increase to R169/m in 2015, while a family of two will pay R199, and a family of three or more will pay R219. There have also been more corporate sponsorship benefits and new partners announced.
Do you like the idea of a flexible medical savings account that gives you control over day-to-day benefits?
TOPMED
9.9%
The overall average contribution for 2015 will be 9.9 per cent. In 2014, TopMed grew the number of principal members, and the average age remained constant at 47 years old. TopMed benefit limits for 2015 increased according to CPI. The Private Fund 2 has been removed from the Rainbow and Paladin options, and the Vitamin benefit has also changed from a percentage to a rand value on these two options. A standardised trauma benefit would be available across all options, and the dentistry benefit has been transferred to day-to-day benefits on the Professional and Savings options. TopMed also announced the inclusion of a specialist benefit on the Network option, of R800 per family, and highlighted an expansion into wellness programmes. The scheme will launch a mobile application that is available to members and brokers from January 2015, on Apple, Android, and Windows devices. The app will allow members and brokers to view documents, log enquiries, view benefits, scan and upload documents, find a provider and check health records. Members will also be able to update profiles, verify scheme tariffs, get member alerts, view or request authorisations and chronic formulary, and brokers can track new business, and get quick quotes.
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MEDIHELP
12.5%
The overall average contribution for 2015 will be 12.5 per cent, which Medihelp principal officer, Heyn van Rooyen, said was not a haphazard move, but a carefully weighed decision. The scheme will add SaveUp to all of its product options after previously only offering it on one option. This is in response to market demand, and is said to add value to members who have more choice and flexibility, as well as adding value to advisers and suppliers. Strata Healthcare management, Medihelp’s administrator, will also be selling Guardrisk gap cover in cell captive in 2015.
Do you like the flexibility of a savings account, but also want the security of a safety net should your needs increase unexpectedly?
The scheme has been busy with its transformation strategy and has put great effort into delivering an individualised engagement experience for members in 2015. For 2015 the scheme announced an increase in health awareness through online health engagement through the website and app, new health assessments benefits at designated service providers (DSPs), and an increase in preventative benefits such as immunisations at DSPs, now including HPV vaccination for boys between 10 and 26 years. Six co-payments were removed: reflux surgery; endometrial ablation; functional nasal surgery;
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myringotomy; excision of skin lesions and hysterectomy. The nominated prescribed minimum benefit (PMB) specialist networks were introduced in 2014 across all options and disciplines and the focus in 2015 will be on increasing network compliance, enhancing the efficiency of the network and expanding it. Medihelp also launched ‘Healthprint’ wellness programme, which is free. By completing Healthprint Basic profiles and sharing health data, members can access preventative care benefits according to their benefit option.
Alternatively, do you prefer out of hospital benefits to be covered by the scheme, subject to insured limits?
Bonitas_DPS.pdf
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p We provide options for every individual, within each kind of environment.
Hospital plans to choose from are Maxima EntryZone, from R1 073pm and Maxima Core, from R1 529pm.Maxima EntryZone offers unlimited hospitalisation at Network Hospitals only, while Maxima Core offers unlimited hospitalisation at all private hospitals.
All comprehensive options offer unlimited private hospitalisation, except Maxima StandardNet, that offers unlimited hospi-
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talisation at Network Hospitals only.
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SMART Benefits So it’s the member who scores.
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What sets us apart is that we provide smart-thinking medical aid options that feature unique value-added benefits. With
Our Saver options Maxima EntrySaver, from R1 327pm and Maxima Saver, from R1 751pm. These innovative options suit those looking for the protection of quality hospital cover, but who also want the freedom of a Medical Sav-
these tangible benefits we pay more from Risk than other schemes to protect Medical Savings and ensure members’ day-to-day benefits go even further.
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ings Account to take care of day-to-day healthcare expenses.
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tals, while Maxima EntrySaver offers unlimited hospitalisation at Network Hospitals only.
NEW! From 2015 our saver options will offer unlimited consultations at a
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nominated Network GP, paid from risk
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c Our comprehensive option range consists of Maxima Basis from R1 978pm, Maxima StandardNet from R2 238pm, Maxima Standard from R2 450pm, Maxima Exec from R3 178pm and Maxima Plus from R5 452pm.
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When we talk benefits, we mean serious value-adds like trauma treatment at a casualty ward paid for - whether the member’s admitted to hospital or not, specialised radiology including MRI and CT scans is also paid for without co-payments, again whether
SMART Networks Partnerships ensure first-rate healthcare.
hospitalised or not. Post-hospitalisation treatment after discharge from hospital is covered for up to 30 days to include physiotherapy,
FEDHEALTH has 4 630 General Practitioners contracted through-
pathology, etc together with 7 days of take-home medication paid
out the country, granting members unlimited GP access on all
from Risk. Female contraception - oral, patches, contraceptive
comprehensive options, where consults are paid from Risk and
rings, certain injectables as well as IUDs including Mirena® is also
never from Savings, provided the member makes use of a Partner
paid from Risk on all comprehensive and Saver options.
GP. We also currently have 1 750 pharmacies contracted across the country, which for the
Specialist treatment in hospital is covered IN FULL at over 3 600
member, means no co-payments on dispensing fees. And with
Fedhealth Network Specialists countrywide – with no shortfalls.
regards to Specialists, we currently have 3 685 Specialist Partners
For specialist consultations out of hospital - on comprehensive and
of various disciplines signed-on.
Saver options, we’ve negotiated contracted fixed rates to be paid in full from available Day-to-Day benefits, with all comprehensive
The primary objective of these partnerships is to ensure members
options also offering full accumulation to Threshold.
are able to access first-rate healthcare without having to resort to additional out-of-pocket expenses.
And to never touch members’ Savings, visits to over 4 600 Network GPs countrywide are offered UNLIMITED on all comprehensive
SMART facts on Fedhealth as a scheme:
options. With our innovative Screening Benefit, even on our hospital
• 75 000 principal members
plans, we now pay for screenings for women’s, children’s, cardiac,
• 148 000 beneficiaries
as well as general health (like a FREE annual flu vaccine). And on
• Dependant ratio to members: 1.02
the most comprehensive options, the benefit even includes screen-
• Average age of principal members: 49
ing and preventative programmes for older members as well.
• Average age of beneficiaries: 38 • Pensioner ratio: 8%
All this is engineered to stretch the member’s day-to-day benefits,
• Solvency rate: 36.5%
not to mention other amazing benefits unique to Fedhealth, like
• Average contribution increase for 2015 benefit
child rates for financially dependent children up to 27 years of age, and upgrades to higher options any time of the year within 30 days of diagnosis of a dread disease or life changing event, together with
year: 10.6% • Proudly retained our AA- Global Credit Rating for the last 8 years.
the incredible FREE Fedhealth Baby Programme, FREE trauma counselling and 24-Hour Fedhealth Nurseline as well.
To experience a comprehensive presentation on everything Fedhealth has to offer, contact National Sales Manager, Chris Norton on chrisn@medscheme.co.za or visit www.fedhealth.co.za
Momentum Health
puts client needs at the core With an average annual contribution increase of 7.9 per cent for 2015, Momentum Health’s stability in terms of product, financials and service offering continues to contribute to the scheme’s favourable outlook. The scheme is also one of very few that managed to grow its membership without seeing a disruption in its average member age.
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amian McHugh, head of Momentum Health marketing and sales, says Momentum’s HealthReturns pioneered a new approach to healthcare funding – one that puts the member in control and, unlike most incentive programmes, does not cost anything.
Damian McHugh
“HealthReturns really set the ball rolling in terms of engineering healthcare benefits through a positive lifestyle,” he continues. “Our offering continues to gain popularity due to increased consumer demand for control over their benefits and budget. With the option to pay HealthReturns into a HealthSaver account, members can increase or, if they so choose, decrease their day-to-day funding as their needs change and can do so without having to change their option too.”
The flexibility in the Momentum Health product range is further seen with the provider choice model where members can save more than 35 per cent on monthly contributions by choosing to make use of certain selected service providers. With affordability a key concern to healthcare consumers today, Momentum encourages both members’ health and financial wellness. The South African healthcare environment has seen a lot of change over the past years, and as part of a greater global response to the burden of disease, and in an effort to prevent absenteeism in the workplace, healthcare funders are increasingly seeing the need to focus on pro-active health awareness and lifestyle changes.
Contributions and benefits With medical inflation that outweighs CPI year-on-year and improved medical technology, usage of benefits and the pressure on schemes to maintain or reach a 25 per cent solvency level, containing annual contribution increases, can often prove challenging in the healthcare industry. With an average annual increase of 7.9 per cent for 2015, McHugh notes that Momentum Health has provided for all the above factors and is well positioned to continue innovating healthcare solutions in the year to come. Given the flexibility associated with the Momentum Health product range, family increases will vary based on the actual option and provider selections made.
On the back of this increase, the scheme still managed to increase benefit limits without having to increase any of its co-payments. Other benefit changes endorse the focus on preventative wellness, and include the extension of benefits for mammograms to members from the age of 38. Technology also allows today’s consumer to better manage their time and increase access to healthcare information, through mobile sites and mobile apps. “Who would have thought 10 years ago that you would be able to instantly check your savings balance on your cellphone, then request authorisation for a procedure while you are in the doctor’s room – a network provider in your neighbourhood that you located via that same app?” McHugh enthuses.
allowing clients greater control over the future of their healthcare is what schemes will rely on to distinguish themselves from the market going forward,” McHugh concludes. Momentum Health’s approach to healthcare means clients can: • Save up to 35 per cent on their contributions, without sacrificing any benefits, through provider choice discounts. • Earn up to R5 400 per adult per year, get free GP visits and increase in-hospital specialist cover through Momentum’s HealthReturns programme in only a few steps, including: going for a free health assessment, complying with appropriate treatment where applicable, and being active. • Enjoy a variety of preventative care benefits under the
Health Platform benefit, including an annual Health Assessment, a host of maternity benefits and more. • Make provision for healthcare expenses such as vitamins and co-payments, through the HealthSaver. • Remotely access emergency numbers, member details, claims statements and more through cell phone, mobi app, or the mobisite. • Join Momentum’s rewards and wellness programme, Multiply, and receive discounts from more than 40 providers such as Virgin Active, New Metro, Garmin and more.
“Catering for members’ needs throughout different life stages and
HealthSaver
Members can fund their day-to-day cover for free – Momentum’s HealthSaver account lets members choose if they wish to contribute, when they want to and as much as they choose to. It also boosts the amount HealthReturns members qualify for, leaving members with funds to cover expenses ranging from vitamins to corrective eye surgery. These components vary across different options, allowing clients to choose their level of cover and tailor a programme most appropriate to their needs. The different options/ contributions for 2015 include (for single member):
Momentum Health’s benefit structure is made up of four components:
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Health Platform benefit
Major medical benefit
Chronic benefit
Day-to-day benefit
This is available to all Momentum Health members and paid by the scheme (subject to pre-notification). Thus, day-to-day benefits are not reduced. The Health Platform encourages health awareness, enhances quality of life and gives peace of mind through preventative care, early detection, leading maternity programmes, management of certain diseases, health education and advice and emergency cover.
This provides cover for hospitalisation and certain out-ofhospital procedures that can safely be performed in doctors rooms, registered day clinics or out patient facilities provided treatment is clinically appropriate and has been pre-authorised.
This covers certain life-threatening conditions that need ongoing treatment. It includes cover for the 26 chronic disease list conditions, which form part of the prescribed minimum benefits (PMBs). Chronic benefits are subject to registration and approval.
This provides for day-today medical expenses such as doctors visits and prescribed medication. Clients have the choice of adding more day-to-day cover through the HealthSaver.
• Ingwe option: for 2015, contributions range from R349/m to R1 880/m • Access option: for 2015, contributions are R1 569/m • Custom option - for 2015, contributions range from R1 068/m to R1 705/m • Incentive option: for 2015, contributions range from R1 391/m to R2 247/m • Extender option: for 2015, contributions range from R3 005/m to R4 200/m • Summit option: for 2015, contributions are R6 043/m
Premiums could come down, drastically.
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tools, activities and assessments, the Programme can get you happier and healthier in a short space of time, if you engage with it as suggested.
As one of the largest programmes of its kind, Multiply is about rewarding people for taking care of their well-being. With discounts, benefits and offers from over 40 well-known brands and partners and a wide range of fitness, health, and wellness measurement
At Momentum we believe that wellness is not just about physical health – it’s also about managing stress, and one of the best ways to limit stress is to be aware of and in control of your financial status. Multiply is the only wellness and rewards programme incentivising financial wellness. Here are some of the great ways we have linked Multiply with our financial products.
y joining Multiply, any Myriad, FundsAtWork and Momentum Health policy holders can enjoy savings of up to 60% on their monthly insurance premiums. Multiply, Momentum’s wellness and rewards programme, works with clients to make it easier and more affordable to take care of their health and financial wellness.
We invest in all-round wellness from physical to financial
Myriad and Multiply, for better health and greater wealth Discounts from 10% to 60% on premiums Momentum Myriad offers complete protection against
financial risks associated with death, disability, impairment, critical illness and longevity. When Myriad policyholders join Multiply, they automatically qualify for a 10% saving on their Myriad premiums, but they can extend that up to 60% by progressing through the Multiply statuses – Bronze, Silver, Gold, Platinum and Private Club. Progressing through the statuses by completing health assessments and other steps, such as minimum levels of physical activity, will give Myriad policyholders access to discounts at Multiply’s many rewards partners, and on other Momentum products too.
Health Returns and Rewards Actual cash paid back into their Health Saver accounts. Momentum believes that medical schemes should not only support their members in times of illness – they should actively assist them in preventing and detecting illness as early as possible. Multiply incentivises members of Momentum Health to be aware of their health status by offering HealthReturns, which pays members up to R5 400 per annum for being active and dedicated to living a healthy lifestyle. Members can elect to have their HealthReturns paid into their bank account, or into their HealthSaver medical savings account.
Making your money work harder Up to 25% back Momentum customers who hold an income protection FundsAtWork policy can get up to 25% back on their monthly premiums, with this policy offering solutions that provide income continuation for various life circumstances and events. These could be disability such as dread disease or unexpected retirement that limit the policyholder’s income earning potential, or death. Enjoying the rewards Engaging with the Multiply programme, through all the assessments and activities earn members more points and takes them to higher statuses – and of course more rewards. Multiply members can make use of the SaveAs-You-Gym benefit from Virgin Active and Planet Fitness, and they can benefit from savings at Cycle Lab, Pro Shop, Mango Airlines, DisChem, Avis and Nu Metro. The Multiply Online Shop gives members significant discounts on a wide range of products, including wearable technology products like the Jawbone and the Garmin Vivo. Members can also take advantage of free or discounted tickets to cricket matches where Momentum is involved in team sponsorship. These partnerships – and the many others listed on the Multiply website – make it easier for Multiply members to save money, giving them the added spending power to enjoy the better things in life.
For more information about Multiply visit
www.momentum.co.za/multiply
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O’DONOGHUE & ASSOCIATES 34824RSA
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ABSENTEEISM
Sick days can cost you and your Company. A dedicated nurse will manage the health risks of your own work force. ISN'T PREVENTION ALWAYS BETTER THAN CURE?
All pri me
Ve Afr be aro mo
As a TopMed Medical Scheme client, our registered nurses not only know you and your employees’ medical history, they're qualified to help them make the lifestyle choices they need to improve their health.
Call: 0860 00 21 58 or visit www.topmed.co.za
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Your Plan For A Healthier Life.
To stu Pa (an
SOMETHING NEW AND EXCITING FROM YOUR TRUSTED HEALTH PARTNER We may be over 40 years old but because we are continually reinventing ourselves we remain at the top of the tree when it comes to offering relevant value for money products and services, which is just what our members want. TopMed is passionate about healthcare and we believe that our holistic and innovative Nurse Based approach, coupled with financial stability, efficient administration and personal service, enables us to put our members first. We not only offer the best range of value for money benefit options, we also contract with the best partners to ensure we deliver what we promise. Since moving to Private Health Administrators, our Administrator and Managed Care Partner, a year ago, our ability to roll out new and innovative benefits and services has increased dramatically.
STAYING ON TOP The success of a good business depends on its ability to stay relevant. Our recent acquisition has created an opportunity to again relook at our product and service offering. With our revamped 2014 range we now offer seven benefit options which we can arguably claim to provide the best all-round benefits and service on the market.
YOUR HEALTH IS OUR TOP PRIORITY
TopMed Active Saver is a New Generation Savings option designed specifically for the young active individuals/families and is an industry winner at just over R1195 a month.
TOP PRE-NATAL AND MATERNITY BENEFITS (except Network Option) Not only does TopMed look after you when you are sick, but we are also proud of our Maternity Benefit, which offers our new moms up to 12 ante-natal classes and 12 consultations, two pregnancy scans and pregnancy vitamins. In addition, we will send you an updated book on Childcare as well as assign you to a Maternity case manager who will engage with you on a regular basis as required.
ADDITIONAL WELLNESS BENEFITS TopMed offers a comprehensive Wellness Benefit on all benefit options except Network which has its own dedicated benefit programme. This benefit allows members access to certain preventative screening tests which are payable from TopMed’s Major Medical Benefit, thus extending members’ day-to-day benefits.
So….Whether you require major medical (hospital), prescribed minimum benefits (PMB), day-to-day or chronic medication cover, TopMed’s seven different benefit options ensure you get value-for-money medical cover that suits your individual needs. We offer specially tailored solutions to suit your healthcare needs and lifestyle, which includes; two Traditional options, three New Generation Savings options, one Hospital and one Low Cost Network option.
EXTENDED MAJOR MEDICAL BENEFITS
UNBEATABLE VALUE
It isn’t because we are super clever that we think we know what our members need... it is because of our unique Nurse Based Model. The TopMed Nurses get really close to our members and their families and are able to offer them support and guidance which members at other schemes can only dream of. We get to know our members better.
All of TopMed’s options offer comprehensive private hospitalisation and insured major medical benefits. Very few medical schemes cater for South Africa’s future leaders. TopMed offers TWO benefit options with unique features designed around the needs of the young and upwardly mobile.
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Option provides comprehensive cover, including a private hospital of choice, from as little as R720* per month, regardless of whether the student or their parents pay the premium.
TopMed Network option allows full-time students into the lowest income band category. Particularly attractive to future professionals (and their parents), our entry level Network
TopMed provides an Extended Major Medical Benefit on all options except the Network Option. This allows members access to extended rehabilitation benefits for five major procedures: Crime Related Trauma, Heart Attack, Stroke, Hip Replacement and Knee Replacement.
WE KNOW YOU AND WHAT YOU NEED
BENEFIT FOR THE BROKER Because of our unique servicing model, brokers with TopMed members get to spend more time with their clients discussing their financial and other needs and less time on complaints and queries.
CHOOSE THE TOP OPTION FOR YOU TopMed RAINBOW COMPREHENSIVE is for those with considerable healthcare needs. It offers Unlimited Private Hospital cover at up to 300% of the TT. Fully Comprehensive Out of Hospital cover is unlimited after Threshold and includes Unlimited Chronic benefits. TopMed PROFESSIONAL is a top end benefit plan for the higher claimer. It offers Unlimited Private Hospital cover at up to 200% of the TT. Out of Hospital cover is provided through a 25% Medical Savings Account and generous After Threshold benefits. TopMed PALADIN COMPREHENSIVE is for the established family with mid to high healthcare needs. It offers Unlimited Private Hospital cover at up to 150% of the TT and comprehensive Out of Hospital cover with a generous After Threshold benefit. TopMed SAVINGS is for the younger family with lower to middle healthcare needs. It offers Unlimited Private Hospital cover at up to 100% of the TT and a 20% Medical Savings Account for Out of Hospital Cover. TopMed ACTIVE SAVER has been designed specifically for the sportsmen and young families. It offers Unlimited Private Hospital cover and a 20% Medical savings Account for Out of Hospital Cover. TopMed HOSPITAL is a Pure Hospital plan for the younger members who want cover for catastrophic events and who are happy to cover their Out of Hospital needs themselves. In Hospital cover is unlimited at any Private Hospital at up to 150% of the TT. TopMed NETWORK is an exceptionally affordable plan designed to cover the Primary Care Needs of the younger family. Cover is through a defined network of providers and to make it even more affordable, contributions are income based.
A healthy dose of
technology
35% of open schemes have Twitter accounts
89%
of respondents would support telemedicine
78%
consider social media as a strategic means to grow membership
Cell phone use by adults in South Africa rose from 17 per cent to 87 per cent between 2 000 and 2013, with usage increasing year on year among older age groups
57 % of open schemes have Facebook accounts Climate change is regarded as the biggest threat to healthcare globally in the 21st century. The effects of climate change are starting to pose a threat to medical schemes’ reserves as lifestyle diseases increasingly become the new pandemics faced by healthcare providers. Growing urbanisation means a growing economy and better healthcare services, however, this also breeds a new ‘silent pandemic’ in the form of various lifestyle-related diseases.
• Discovery Health – @disc_health has over 738 000 followers • Bonitas – @BonitasMedical has over 390 followers • Medihelp – @Medihelpsa has over 700 followers • Momentum – @Momentum_za has over 5 400 followers • Bestmed – @BestmedSocial has over 430 followers • Fedhealth – @Fedhealth_med has over 680 followers • Genesis – @GenesisMedical has over 1 430 followers
Respondents feel that wellness programmes and disease and lifestyle management initiatives will reduce costs for medical schemes.
50% have seen option buydowns increasing over the past year or two
22%
have current e-Health records for their own members, but these are not fully integrated
75%
of consumers expect healthcare entities to respond within 24 hours to requests via social media
FEDH2729RSA The Cheese Has Moved
Medical scheme members have increasing expectations that intensify with technological advances, and consumers are demanding integrated services from their medical aid. Facebook, Twitter, mobile applications, e-Health and telemedicine are all platforms that medical schemes must embrace. Medical schemes should leverage technology for a competitive edge, while ensuring that the member’s experience of an integrated offering remains in place.
PricewaterhouseCoopers released its 2014 research survey entitled ‘Drivers of change’, which provides insight into how medical schemes in South Africa are keeping up with the trends changing the medical aid landscape. Below are some of the findings from medical schemes and survey respondents.
The
smartest
advisors
are
switching
FEDH2729RSA The Cheese Has Moved
their clients
Legally we’re prohibited from making exaggerated claims about how enlightened we are. But what we can do is give you the facts so you can give your clients the best advice. Like how with 77 years of heritage we’re one of the oldest schemes, with stable reserves and one of the lowest contribution increases for two years straight. How being run by an active member-elected Board allows us to operate with total transparency. And how with a comprehensive option range we care for every individual. We know you’re smart about money. So advise your clients to get quality, value-added medical aid that offers much more for less, simply by offering them a different choice. Ask yourself, are you one of the masses, or one of the leaders? Isn’t it time you switched your clients to Fedhealth?
Call your broker consultant or our contact centre on 0860 002 153 or go to fedhealth.co.za
Fedhealth. Real Medical Aid.
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