Fedhealth aims to maximise member value in 2015

As one of the larger medical schemes in the country, Fedhealth's vision for this coming year is geared to maximising member value through innovation and by managing the risk pool.

The Scheme announced yesterday that though there will be an overall average annual increase on the Maxima range of 10.6%, the benefit structure remains unchanged.

The good news, says Peter Jordan, Principal Officer for Fedhealth is the unlimited GP benefit that we have extended to Maxima Saver and Maxima EntrySaver members for the coming year. “This means these members will now have unlimited access to a nominated Network GP once their Savings are depleted.”

More good news for members is the fact that the scheme stepped into 2014 with a reserve ratio of 40.16% after collecting R2.4 billion in contributions from its members during 2013. “Considering that a 28-32% buffer ideal for our scheme we aim to reduce our reserve ratio to that ideal percentage during 2015 by giving back to our members wherever we can,” says Jordan.

Talking of members, Jordan says the Scheme welcomed 15 500 new members below the age of 40 over the past year, bringing their principal member count to 73 389. "I am please to say that our corporate presence continues to grow. This is evidenced by the fact that 50% of these new members are from that sector.”

He adds that as things stand, 55% of the Scheme’s current members are individuals, 32% are now from the corporate market, marking a 2% increase over the last two years, and the remaining 13% comprise the government sector.

Fedhealth are proudly one of the Schemes with the highest paid claims rate and they have retained their AA- Global Credit Rating now for eight years straight. “The ability to dependably pay claims keeps our members coming back,” says Jordan.

”We take pride in being a Real Medical Aid, and in making smart moves that benefit our members and the scheme in the long run. To do this sustainability with skillful risk management is key,” says Jordan.

“A big focus for 2015 will be the coordination of our members’ care through our 360 degree approach,” he says. This entails GP’s becoming the coordinator of a member’s care. Doctors and patients will work together closely, so that all healthcare needs are met and so that fragmented care, which is not only costly and time consuming, but also dangerous, can be avoided.

Another way of ensuring sustainability is by identifying high-risk members who are likely to develop conditions that can be managed or even avoided through the Beneficiary Risk Management (BRM) Programme. “This value-adding service is in the member’s best interest as prevention or early detection could save both their health and their pocket in future,” says Jordan.

An important measure of sustainability for a scheme is its network arrangements. Jordan says that the primary objective of the Fedhealth Network is to ensure members have access to first-rate healthcare without resorting to unnecessary out-of-pocket expenses. The network’s reach is wide enough for over 98% of all claiming members to have access to a Network GP within 10 kilometers of where they live.

He points out that to date in 2014, 67% of all GP visits have been to contracted doctors, and 82% of all claiming beneficiaries have used the network. “Cost to the Scheme for all GP visits was just under R60 million, and just over R50 million for network visits. That means that 76% of all GP costs were paid out to Network doctors over the current year.”

Keeping to the theme of maximizing member value through innovation, Fedhealth have added a number of new innovations to the mix for the coming year including an innovative Member App, which is available for Apple and Android users allowing members direct access to their option.

“There is also the new smart communication tool, FedChat. This is a dedicated Instant Messenger channel that offers members the convenience of being able to chat online, in real time, with a Fedhealth service consultant during office hours.

The Fedhealth website also features Live Chat which allows both members and random consumers to raise important medical aid questions on the site during office hours with a skilled consultant in a friendly, one-on-one capacity.

Jordan believes that the future of medical schemes lies in preventative healthcare and wellness. This will involve more member education and a genuine commitment from schemes to generate conversations with members. “Not only will this enable the schemes to address their members’ concerns directly, but also to gain a better understanding of their wants and needs.

“Medical aids have a massive responsibility towards their members and transparency will be a key differentiator in future,” concludes Jordan.