Medical schemes get cracking with their 2013 benefit announcements
The traditional “heads up” for the December holiday is when retail stores dust off the tinsel, flashing lights and Christmas carols… When you see these “early warning signs” you know the year has just about run its course and of course there are only 12 W
Both medical scheme brokers and members can be excused for treating the annual benefit announcements with trepidation. Year after year members face the double-edged sword of premium hikes in excess of inflation along with the inevitable erosion of benefits… Will things be different this time around? South Africa’s official CPI has pegged below 6% through 2011/2 and the hope is that medical schemes will limit their 2013 increases to single digits. A quick look at the announcements of two of the country’s largest open medical schemes proves promising, assuming benefits are not cleverly eroded behind the scenes!
Empowering medical schemes members
Momentum Health covers more than 100 000 families and has the youngest principal member profile (as opposed to beneficiary profile) among the larger open schemes. It offers affordable world-class healthcare through on-going innovation and comprehensive complementary products. The scheme’s average contribution increase for its membership has been set at just 7.9% for 2013.
Damian McHugh, Head of Marketing and Sales for Momentum Health, points out that employers (representing groups of scheme members) may experience varying increases due to the option distribution among employees because the scheme applied different increases across its options. He observes that it is also possible for employers, working with their medical schemes brokers or EB consultants, to reduce the overall premium increase by utilising the unique benefit design of the scheme, without necessarily decreasing benefits.
Momentum offers unique product features, such as Provider Choice and Health Saver, which enable members to tailor their increases to better match their needs and level of affordability. The group notes that the perception in the larger medical schemes community that schemes achieve savings by cutting benefits is incorrect. Momentum’s 2013 options include new benefit enhancements and increased benefit limits on all options.
New approaches to benefit utilisation
“Last year we made significant strides in the areas of product innovation, financial strength and superior service, making us a formidable player in private healthcare,” says McHugh. “In 2013 we will be building on our success with a continued focus on safeguarding the interests of our members and enabling better and more innovative solutions to address their wellbeing.”
Benefit enhancements for 2013 include the addition of an antenatal visit (paid for by the scheme) on two of its lower-end options, and the provision of doula benefits on all options as an alternative to the use of a midwife for home births. Momentum Health will also introduce its own primary healthcare provider networks for two of its options to service the out-of-hospital needs of those members.
Momentum Health’s benefit philosophy strongly endorses the notion that prevention is better than cure and therefore encourages its members to follow an active, healthy lifestyle. The group’s already popular HealthReturns program has therefore been further enhanced for 2013. “With a future-focused product philosophy in place, we are confident that we will remain the best choice for private healthcare consumers into the future,” concludes McHugh.
Largest open medical scheme gears up to meet its members’ needs
Discovery Health announced slightly steeper premium increases for 2013. Principal members can expect contribution increases of between 9.8% and 11.8%. DHMS also announced significant benefit enhancements, increased access to healthcare for low-income earners and greater rewards for healthy living. Few will question the scheme’s performance to date. It has grown by more than 100000 lives each year since 2008, to cover 2.4 million lives. Many medical schemes brokers stick with DHMS due to its impressive financial track record. Reserves have grown to R8.1 billion and the scheme is recognised for its claims paying ability, with an AA+ credit rating from international credit rating agency Global Credit Ratings.
Is the 2013 premium increase warranted? The scheme believes so! According to Discovery Health CEO, Dr Jonathan Broomberg, the DHMS contribution increases are set at a level that factors in benefit enhancements, while allowing for growth and solvency requirements, as well as making provision for the effect of increased utilisation and medical inflation. “Discovery Health has been successful in managing these complex issues and DHMS continues to perform exceptionally well across all key metrics,” he says. “Our strategic focus during 2013 will be on providing the best of care to all our members while enhancing benefits, and rewarding people for maintaining good health”.
It is becoming increasingly difficult for medical schemes brokers and their clients to stay abreast of the evolving medical schemes environment. The presentations and press releases we have seen this year suggest that understanding what your medical scheme will and will not pay for, as well as how to best structure your benefit option and manage the associated healthy lifestyles program to maximise the value you receive from the scheme, are more complex than ever. Given these complexities both employers and individual members should consult extensively before deciding on their benefit options each year.
Editor’s thoughts: I am a firm believer in simple solutions… My personal experience with medical aid is that the member has little interest in benefits and benefit options until such time as a medical emergency occurs. The member then faces an uphill battle to determine what can be claimed – where it can be claimed – and how much is left over for his or her account. Is there an argument for medical schemes to simplify their product offerings so that consumers can better understand the benefits they are entitled to? Please add your comment below, or send it to [email protected]
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