Member choice and value central to 2021 healthcare cover decisions

Enter the era of bespoke healthcare

South African medical scheme members and employer groups should be reviewing their healthcare cover for next year with particularly close attention to value, affordability and access to benefits where they may be needed most. Commenting on the latest cost-saving options and choices on offer in the industry, Bianca Viljoen, spokesperson for Health Squared Medical Scheme, says members are increasingly looking for the security of quantifiable Rand value in their choice of benefit option for 2021.

“This time last year, surely there were not many people considering the possibility of a global pandemic when they reviewed their medical scheme benefit options to make their selection for the year ahead. A year down the line there is heightened awareness for the value of meaningful, quality healthcare cover that can be completely relied upon in times of need,” she says.

“This past year then has clearly shown that the time has come to think differently about health and healthcare cover with medical scheme members and corporate clients increasingly seeking tangible value and flexible benefits that ensure members are covered whatever 2021 may bring. When confronted with the entirely new health threat of Covid-19, for instance, Health Squared Medical Scheme was among the first to comprehensively cover members’ Covid-19 tests, even for those with negative test results.

“We increasingly find that members want more bespoke cover that affords them greater control over their healthcare benefits. This requires innovative, sustainable benefit design that enhances cover in areas where it means the most to our members,” Viljoen says.

“Here hybrid-type options, such as Health Squared’s brand new Prosper benefit option, come into their own. Geared towards the needs of growing families, this is an ideal choice for members who want a true value proposition to cover healthcare through a combination medical savings account and structured benefits.”

With unlimited private hospitalisation, generous maternity benefits, chronic benefits and extensive day-to-day cover, Prosper benefit option is ideal for those seeking more comprehensive cover affordably. Members remain in control with this highly flexible option, which includes a preventative care benefit to help members protect their long-term health.

Giving members more makes strategic sense
“The core needs of most members are at primary healthcare level. From a scheme perspective, providing members access to more benefits is an active risk management strategy that we have long embraced, as it is proven to ensure much healthier members, better outcomes for members and the Scheme, as well as less secondary and tertiary care,” notes Viljoen.

To create extra value, members can choose to unlock more appointments for General Practitioner, physiotherapist or psychologist consultations within their annual benefit limit at no additional cost.

“An individual on one of our typical options would ordinarily have access to four consultations, however by selecting network providers, Prosper members get two more appointments added to their benefit at no additional cost and with no co-payments. For a household of three or more, instead of the standard nine consultations, families will instead receive 13 doctor, physiotherapy or psychologist consultations for the year.

“Of increasing importance is coordination of care, which creates additional value and supports better outcomes through integrated service delivery and technology across different aspects of healthcare risk management,” she says.

The benefits of cross product integration are available to Health Squared members, providing individuals with an affordable, yet comprehensive, tailormade health insurance and rewards solution. This ensures unmatched flexibility, avoids the problem of overlapping cover, significantly reduced administration processes and one single point of contact across multiple products.

“Ensuring members are able to take good care of their health significantly reduces the chances that they will develop more severe health complications in future. In today’s healthcare market there is no need to compromise on care, no matter what level of cover is required. We have developed affordable, highly flexible options to suit the needs of any individual, family or employer group.”