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Special report
Medical cover options for 2024
Getting the balance right As claims have gone up, most schemes are proposing higher member contributions for 2024 ● Each year, medical schemes announce their contribution increases for the following year, providing members with an opportunity to weigh up the costs vs the benefits and decide whether they want to remain on the same plan, upgrade or downgrade their plans within the scheme. Most schemes allow members to change plans only once a year, on January 1. This year, schemes have proposed increases ranging from 6.9% to as much as 16%, though both the proposed contribution increases and benefits of all schemes are still subject to approval by the Council of Medical Schemes. Medical scheme contribution increases typically exceed consumer price inflation (CPI) by as much as 4%. There are a number of reasons for this, including above-inflation increases in health-care provider costs, a rising burden of disease, increased hospital admission rates, members using their benefits more, expensive new medical technologies and increased instances of fraud, waste and abuse.
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As not-for-profit entities, medical schemes need to ensure that their contribution increases are sufficient to cover the cost of health-care claims for their members in the year ahead. This means that when claims and the cost of healthcare services increase, so does the need to increase contributions. Medical schemes are required by the Medical Schemes Act to have a minimum solvency level of 25% of their gross annualised contributions in reserves. Regulations also require that when a medical scheme increases its contributions, it needs to increase its solvency level by the same proportion. This solvency level is essentially for the protection of members. A failure to maintain the required solvency can have devastating consequences as members of Health Squared Medical Scheme discovered in 2022 when the scheme announced that it would be going into voluntary liquidation, leaving 23,000 beneficiaries without medical aid membership. It later emerged that the scheme had not met its 25% solvency ratio. The Alexforbes Medical Aid Insights report revealed that,
. November 16 - November 22, 2023
over the past 22 years, CPI has averaged 5.5% compared with medical care and health expenses inflation, which has averaged 6.9% a year. Medical scheme contribution inflation has averaged 7.3% in the same period. Most medical schemes offer a variety of plans to suit the different life stages, health
Network plans are an effective and affordable way to maintain the benefit cover you need Anthea Towert, principal consultant at Insight Advisory Solutions
needs and affordability of members. Those plans with higher contributions tend to offer more benefits. More affordable plans typically have more restrictions, including co-payments, which is why it’s important that members understand the rules for each plan. Across the board, most schemes have experienced increased claims in the past year. The proposed contribution increases reflect this trend. Fedhealth announced a weighted average increase across all its plans of 10.8%. Both Mo-
mentum Medical Scheme and Bestmed Medical Scheme announced weighted average increases of 9.6% while Discovery Health announced a 7.5% weighted average increase. Discovery Health has some significant differences in increases, with the Executive plans having a proposed 12.9% increase and the Classic Comprehensive series (excluding Classic Smart Comprehensive) an 11.9% rise. While Discovery’s Saver series options have below-inflation increases, members need to factor in that their medical savings allocations have been cut significantly. Medshield announced a proposed 8.9% average weighted increase, funding a portion of the increases from its reserves, increasing selected benefits by 5% across all plans and decreasing some copayments. Some plans have no increases for 2024. Kevin Aron, principal officer at Medshield, says members can ensure they get the best value for money out of their medical scheme by choosing a plan that is structured to suit their lifestyle and age. Medshield offers an affordable digital plan called MediCurve which is aimed at young, healthy, tech-savvy, first-time
Special Report ????? medical aid buyers with free, unlimited virtual GP consultations through the Medshield SmartCare benefits. MediSwift is a cost-effective, value-based hospital plan aimed at amateur sports enthusiasts. The MediPhila option protects young families from unforeseen medical costs through unlimited hospital cover for prescribed minimum benefit conditions. MediValue is the ideal option for individuals needing unlimited hospital and day-to-day partial cover. MediSaver is perfect for independent individuals who want to manage their own out-of-hospital healthcare expenses through a personal savings account with unlimited hospital cover. MediPlus is the answer for middle- to upper-income earners, offering unlimited inhospital cover and a generous
day-to-day limit. MediBonus is the best choice for corporate employees and individuals who need comprehensive unlimited in-hospital cover and extensive day-to-day benefits. PremiumPlus provides the most comprehensive cover with freedom of choice, including no network restrictions and 200% cover for specific inhospital procedures. Bonitas Medical Fund announced a weighted increase of 6.9%, which represents the lowest contribution increases across the large open medical schemes. The average increase across nine of its plans is 6%. Lee Callakoppen, principal officer of Bonitas, says that despite an erratic claims catch-up trend which emerged in the past year, the scheme has taken a conservative approach to remain sustainable for members, regardless of in-
Kevin Aron: Choose a plan that’s structured to your lifestyle and age
creased claim patterns. Bonitas conducted in-depth research over the past year to identify ways it could enhance benefits and provide members with more value. It analysed feedback from more than 10,000 member surveys and researched global health-care protocols, trends and disease burden rates in South Africa. As a result of this research, it has identified strategies to reduce
out-of-pocket expenses and provided additional preventative and managed care. The scheme’s changes for 2024 include networks at favourable rates for members, with discounted tariffs aimed at reducing or eliminating copayments. The networks apply to GPs, medication, dentistry, optical, specialists and hospitals. It has also enhanced its specialist reimbursement rates, which allows 85% of members to have full cover, wallet-free specialist visits. Bonitas has also enhanced its range of Care programmes to cover audiology, HIV/Aids, cancer, diabetes, mental health, back and neck, hip and knee replacements and a hospitalat-home offering. A mental health programme has been introduced across all plans for 2024, with depression included as a chronic con-
We’re with you through all the ups and downs SIGN UP member@medshield.co.za 086 000 2120 www.medshield.co.za November 16 - November 22, 2023
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Special Report Medical ????? cover options for 2024
Lee Callakoppen: Bonitas has taken a conservative approach to remain sustainable
dition. The scheme also offers its members access to Panda, a digital platform available through the Bonitas app, which provides members with easy access to expert help, mental health information and community support. A network of physiotherapists has been established, so members can access the Bon-
itas back and neck programme in more remote areas. A new benefit for 2024 is the Bonitas Be Better Benefit, which ensures members have access to preventative screenings for early detection. As an added bonus for 2024, childhood immunisations following the state vaccine schedule will be added to an additional six plans. The scheme has lowered the age to have the human papilloma vaccine to prevent cervical cancer on all plans. It has also increased the child dependant age to 24 years, regardless of whether they are studying. Bonitas Benefit Booster provides members with access to additional funds to use for out-of-hospital expenses and has been boosted significantly for 2024. Two emergency
room consultations and treatments per family have been added on all options. Anthea Towert, principal consultant at Insight Advisory Solutions says the ultimate aim is to ensure adequate cover for major medical incidents. “Cover for hospital and major medical expenses needs to be the primary building block for a health-care plan, providing optimal cover for high-risk exposure,” says Towert. “Hospital plans are far more affordable than comprehensive plans, but need to be combined with a medical savings account or a personal savings account to fund planned, non-emergency day-to-day expenses.” She advises linking a medical gap cover with a hospital benefit plan to provide supplementary insurance to cover the
shortfall where doctors charge above medical rates or when co-payments and sublimits apply, particularly in cases of major surgeries, cancer treatment or childbirth. Another tip to achieve more cost-effective health-care cover, she says, is to explore the network options offered by the medical scheme. “Network plans are an effective and affordable way to maintain the benefit cover you need, but importantly, make sure there is adequate coverage near where you live or work,” she says. Balancing affordability with appropriate health-care cover, she says, requires members to be proactive and informed. Writer: Lynette Dicey Sales: Cris Stock
GET MORE VALUE WITH THE BENEFIT BOOSTER to use for out-of-hospital expenses.
JOIN NOW www.bonitas.co.za Subject to approval by the Council for Medical Schemes
0860 002 108 | bonitas.co.za |
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. November 16 - November 22, 2023