Why South Africans need a true healthcare adviser, not just a broker

When it comes to the healthcare industry, advice matters. The kind of advice that cuts through complexity, balances affordability with adequacy, and empowers people to make informed decisions that impact their wellbeing.

These days, organisations are being let down by the kind of advice that prioritises plan selection over people.

Karin Mitchelmore, Executive Head of Healthcare Consulting at advisory firm NMG Benefits, believes that brokers must evolve from intermediaries to strategic advisers who can truly guide organisations through one of the most fragmented and misunderstood parts of employee benefits.

A new environment and what has changed.
The traditional 70/30 split between corporate and retail healthcare members has flattened significantly. As more employers move away from subsidies or shift towards cost-to-company models, individuals are taking on more responsibility for their cover. That shift in burden, from employer to employee, means the role of a broker has changed fundamentally. And so should the expectations we have of them.

As a trusted advisory firm, our job is no longer just about optimising a medical aid plan once a year. It is about being a trusted partner to the employer and an accessible resource for every employee. We need to understand their workforce, their culture, their risks, and their affordability constraints, and then create tailored strategies that keep their people healthy, covered, and productive.

That includes everything from benefit counselling and one-on-one plan reviews to structuring hybrid solutions that integrate medical insurance and medical aid across income levels. It includes negotiating directly with product providers for underwriting concessions that make a difference, like removing waiting periods for new hires or ensuring chronic medication continuity during plan changes.

Countering AI
In a market saturated with comparison tools and AI-generated summaries, NMG Benefits offers something more important: insight. “We do not believe that a chatbot can replace an informed conversation that factors in your life stage, family plans, health history, budget, and future goals. Nor do we believe that algorithms can explain the implications of hospital shortfalls, waiting periods, or the dangers of losing credible coverage after opting out of a medical scheme”, says Mitchelmore.

The truth is that the average person does not know what they are covered for. Not really. They see a premium, some savings, and assume they are protected. That is, until they claim and discover the gaps. One of our key goals is education. Our teams are constantly on the ground, in boardrooms and staffrooms, running sessions, answering questions, explaining the basics and the nuances.

We have also invested in building member-facing tools that provide instant clarity. For example, a chronic medicine calculator that shows whether a treatment will be covered under a different plan, or a hospitalisation estimator that forecasts likely shortfalls based on real data. These tools are not gimmicks but are born out of actuarial insight, built by experts, and designed to empower people before they sign on the dotted line.

An integrated fee
This kind of advice does not come at an extra cost. Most people do not realise the broker fee is already embedded in their plan. Which means the difference between good advice and bad advice is not about price but about who you choose to guide you.

Employers have a responsibility to offer more than compliance. They have an opportunity to be part of the solution by ensuring their employees are covered and truly cared for.

That is where the role of a trusted adviser becomes indispensable by helping employers and employees make better decisions with the information they already have and the support they did not know they needed.

Because behind every medical aid plan is a person. And behind every person is a story. Our job is to make sure they are protected, understood, and never alone in navigating one of life’s most essential decisions.