CompCare covers all bases ahead of 2024

Pictured here left to right at the CompCare Medical Scheme 2024 benefit round table discussion are Dr Odwa Mazwai, managing director at Universal Care; Carl Yssel, managing partner at 3ONE Consulting Actuaries; Irene Rogers, general manager sales and distribution at Universal Healthcare (standing); Jailoshini Naidoo, presenter; Josua Joubert, chief executive and principal officer of CompCare Medical Scheme; CompCare Platinum Broker Award winner Esther Oosthuizen from Estmed Health Care Consultants (standing); and Charlton Murove, head of research at the Board of Healthcare Funders

Medical scheme takes healthy, proactive approach to uncertainty

“In a climate of uncertainty surrounding healthcare funding legislation, the focus has turned to medical schemes that prioritise responsible planning, transparency, and proactive care delivery to consumers,” says Josua Joubert, the chief executive and principal officer of CompCare Medical Scheme.

During a round table discussion ahead of the 2024 benefit year, Joubert shed new light on some of the critical steps that schemes must take to secure their ongoing sustainability for members. “With a limited pool of individuals who can afford medical scheme coverage in the country, amalgamation has emerged as a pivotal mechanism for medical schemes when it comes to fostering growth,” he added.

Highlighting the critical importance of values alignment in the success of such mergers, Joubert revealed that CompCare had invested considerable time and resources to identify a partner that would ensure a seamless integration to benefit both schemes and their members.

“Among numerous possible contenders, Suremed emerged as the most suitable, like-minded future partner for CompCare, and plans are well underway for the two schemes to merge on 1 January 2024, should all the necessary permissions be granted. This strategic merger promises to be mutually beneficial for all stakeholders involved. While members are poised to gain from improved affordability, CompCare anticipates increasing its current membership base, simultaneously fortifying its financial reserves. CompCare's financial reserves currently stand at a robust 30.9%, comfortably surpassing the industry-mandated threshold of 25%.

“The collaboration between CompCare and Suremed is a testament to our unwavering commitment to members and healthcare consumers. It underscores our proactive efforts to implement innovative solutions that guarantee the ongoing provision of authentic care, fortified financial stability, and sustainable growth. We are dedicated to shaping a brighter future for healthcare in which existing and prospective members can place their trust," asserts Joubert.Top of Form
Bottom of Form


Charlton Murove, head of research at the Board of Healthcare Funders who attended the round table discussion session, noted that medical schemes with a long-term view of caring for members operate in a challenging regulatory environment, which has yet to evolve to support sustainability.

“Medical schemes by definition must cover prescribed minimum benefits (PMBs) which provide much-needed cover, however, the costs of these benefits have never been pre-determined and are not always within reason.

“Health insurance products, on the other hand, are sold like medical scheme products, they look like medical scheme products, but they provide a very different kind of cover. However, because they are more affordable, they are popular among younger healthcare consumers, which leaves medical schemes with an ageing market,” Murove said. “Enabling medical schemes to offer low-cost options that are not obliged to cover the full suite of PMBs would significantly improve affordability and accessibility to those seeking well-rounded healthcare cover.”

Joubert pointed out that CompCare has already developed a low-income benefit option (LCBO) based on independent actuarial research, which it is ready to take to market as soon as the required regulatory support has been granted.

Further concerns noted during the discussion included fraud, waste, and abuse, which, according to Carl Yssel, managing partner at 3ONE Consulting Actuaries, are estimated to cost the industry R30 billion annually.

“Many medical scheme members will often utilise benefits simply because they are available and not because they have a medical reason. This individualistic approach is short-sighted as it needlessly erodes the funds of a scheme while forcing contribution rates upwards, which naturally has a negative impact on every member,” he points out.

Commenting further on member perceptions around their medical scheme, Joubert noted that when it comes to annual contribution increases, members would do well to take note of rand amounts, instead of just focusing on the percentile increase, and should question what other changes are being implemented alongside that.

“A percentage is not meaningful on its own – 10% of R1000 and 20% of 500 come to the same amount. What is relevant is the rand amount that must be accounted for in your monthly budget and whether benefits are being enriched or reduced. That will provide a far more precise picture of what you are getting in return for what you actually pay.

“For example, on CompCare’s 2024 benefits which are in the final stages of approval with the Council for Medical Schemes, we are implementing a monthly increase of R340 on our most popular option. This may mean one less Friday night takeaway, but what you are receiving in return is an increase of 10% in benefit limits in clinical psychology, psychiatry, antenatal classes, children’s emergency room visits, conservative dentistry, specialised radiology, and pathology among others."

“This is in addition to the market-leading speciality healthcare bundles for which we are known, and which are meticulously designed to cater to our members’ diverse needs. These bundles include kids' health, mental health, women’s and men’s health, preventative care, active lifestyle, professional and adventure sports, and a travel bundle.

Benefit changes are minimal and some option increases are as low as 8.9% while our average weighted increase is 13.9% in support of our financially responsible approach. With a proud 45-year track record as guardians of member health, we are confident that we can stand our members in good stead for many decades.”

Joubert added that CompCare is taking a proactive stance on finding innovative solutions to address affordability issues within the current regulatory framework and that the scheme will be launching a digital option plan that is fully tech-enabled, resulting in considerable savings.

Addressing the question of medical scheme longevity in light of the NHI, Dr Odwa Mazwai, managing director at Universal Care, noted that universal health coverage is sorely needed in South Africa and that a workable solution for all must be found.

“While this is unquestionably true, we cannot know how or when such a system will materialise in practical terms, particularly given that we only have a tax base of about 30% in South Africa, as has been pointed out here today.

“This means that we need legislative support to meet the needs of many more South Africans, and if we do not take action now, we may find ourselves in the same position in the years to come. Medical schemes will continue to play a vital role in providing access to quality healthcare even in the case of NHI, and it is crucial to continue with this form of much needed cover while a new way forward is plotted,” concluded Dr Mazwai.