Good news for medical scheme members

Stability, value and innovation feature prominently at CompCare, BCIMA and Makhoti

In recent times the South African private healthcare funding landscape has increasingly come under threat due to high costs resulting in limited value for hard-pressed healthcare consumers.

However, the recent joint 2012 product launch of three diverse medical schemes delivered refreshingly goodnews for private healthcare consumers. Stability, cost-efficiency and enhanced benefits featured prominently in the product line-up of each scheme – an unexpected display given the current healthcare funding climate.

Commenting on this development, Dr Johan Pretorius, Chief Executive Officer of Universal Healthcare, the administrator of CompCare Wellness Medical Scheme, the Building and Construction Medical Aid Fund (BCIMA) and Makhoti Medical Scheme, said: “The schemes all made a supreme effort to deliver stability, value and innovation to their members. CompCare announced contribution rate increases ranging from 4.9% to 7.9%, while BCIMA’s increase was an exceptionally low 5%. The Makhoti increase came in at 7.6% on average.”

“In the light of current cost pressures being reported throughout the industry this is exactly what healthcare consumers need to hear. It is refreshing and unheard of to see extraordinarily high reserves and product innovation matched with such low contribution increases. Come 2012 the members of these schemes will all be in a substantially stronger position than the members of most other medical schemes. We need more of this type of action rather than the rhetoric that has so long blighted progress in the private healthcare industry.”

According to Catharina Sevillano-Barredo, Financial Director of Universal Healthcare, each of the three schemes reflected robust reserves. “Makhoti’s reserves reached an all time high of 125% while BCIMA achieved an impressive 72% and CompCare turned in a solid 37%. The reserves of these schemes have significantly improved since Universal Healthcare took over their administration in 2009. With a healthydrop in non-healthcare expenditure from 16% in 2009 to 12.8% in 2011 CompCare is a prime example of what responsible corporate governance can achieve. The stability of the three schemes was further reinforced with a lower than average beneficiary age of 29.30 years for Makhoti, 30.68 for BCIMA and 38.90 years for CompCare.”

Sevillano-Barredo noted that financial stability and sustainability were clearly top of mind with CompCare’s announcement that their Networx option was now the most affordable network option on the market. Smart product innovations have further ensured that healthcare benefits remain a cut above the rest.

Considerable value was added for CompCare members, notes Josua Joubert, General Manager of Marketing and Distribution at Universal Healthcare, with the introduction of a personal healthcare wallet that acts as a savings mechanism “with a difference”. Joubert explains that this new savings tool allows funds to be transferred from oneyear to the next as well as offering members the choice of using funds accumulated to make co-payments in times of need.

Noteworthy benefit increases from CompCare included an unlimited oncology benefit on all registered PMB conditions and the introduction of Attention Deficit Hyperactivity Disorder(ADHD) as a chronic condition on the Symmetry option. Female members will be pleased to know that contraceptives as well as the cervical cancer vaccine will now be funded from their risk benefits.

According to Sevillano-Barredo, BCIMA members saw the lowest contribution rates increase to be reported by any scheme in South Africa. Over and above this, benefits and sub-limits were increased by an impressive average of 10%. The Fund has a reputation for being a value-for-money fund, which is more affordable than the average medical scheme. While the Registrar of Medical Schemes granted BCIMA exemption in respect of the provision of Prescribed Minimum Benefits (PMBs) the Fund continues to pay for PMB treatments in line with its annual limits.

BCIMA’s contributions and benefits are structured per family and members have the flexibility of joining the Fund for specific contract periods. Another point of convenience is the fact that members are afforded freedom of choice when itcomes to selecting a service provider, as no network restrictions apply. The Scheme also covers the services of traditional healers.

The members of Makhoti, a scheme with a solvency level of an unprecedented scale at 125%, will be pleased to learn that a host of excellent new benefits were announced for 2012. With a young member profile and a mandate of being “by workers, for workers” the Scheme caters primarily for the needs of blue-collar workers.

Highlights for Makhoti in 2012 include unlimited HIV/Aids treatment, unlimited GP visits, unlimited acute and chronic medication and unlimited basic dentistry. The Scheme has developed a strong foothold in the South African labour market where it has forged excellent relationships with unions and employers alike. It was originally founded in 1976 under the name Good Hope Medical Aid Society.

Joubert points out that Universal Healthcare works hand-in-glove with the schemes under its administration toprovide members with access to the latest technological advances, thereby adding value to the overall member experience. “One such innovation is our new Health eFile, a quick reference coding system that relays vital medical information to healthcare providers. For example, should a member be in an accident, emergency service personnel simply have to scan the quick reference code ofthat member onto a device such as a smart phone and they will be provided with instant access to the member’s full medical records. This service can make the difference between life and death in an emergency situation and was developed thanks to the exceptional internal information technology systems and platforms that were put in place by Universal over the years.”

Right now Universal Healthcare can also lay claim to one of the largest multi-disciplinary provider networks in the country. Furthermore, Universal 360°, the company’s health and wellness loyalty programme, is one of the best-priced and most comprehensive programmes of its kind in South Africa. Members of the schemes under the administration of Universal Healthcare, as well as corporate clients, healthcare consultants, network doctors and members of the Universal WorkerPlan, all have access to this service from as little as R79 a month per member. This is almost half the cost of similar plans that are currently available on the market.

In the view of Johan Pretorius, it has long been a recurring hurdle for medical schemes that their services are increasingly being viewed by hard-pressed members as a grudge purchase. “The dramatic increases in medical aid rates, which are consistently above the rate of consumer inflation, are making it even more difficult to reach this market. The shifts that are taking place in the industry are without doubt a challenge, but the attitude at Universal Healthcare and the schemes under our administration is that by taking an innovative approach and being proactive we can change thestatus quo,” concludes Pretorius.