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Medihelp Medical Scheme announces 2024 contribution increases

04 October 2023 Medihelp Medical Scheme

Medihelp has announced a weighted average contribution increase across all its benefit plans of 15,97% from 1 January 2024.

The medical scheme signalled that a return to pre-COVID benefit utilisation and increases in the cost of care has impacted the Scheme’s claims ratio. Exceptional membership growth has also added pressure on the Scheme’s reserve levels.

The Scheme’s adjustment should be set off against the past three years’ average adjustments of 5,8%, -0,45%, and 7,5%, bringing it to an average increase of 7,2% per year over four years. The majority of Medihelp’s options are currently priced lowest in the market, which provides a very low base for adjustment and ensures that the product range remains well-positioned despite the increase.

Johan Viljoen, acting Principal Officer at Medihelp said that the percentage increase of contributions for 2024 has not been an easy decision, but while Medihelp is well aware of the impact it will have on members, it is the responsible decision. Medihelp also took a firm decision not to cut benefits, change products or limit members' benefits. This means that savings accounts and day-to-day benefits, among others, have not been reduced.

“Medihelp decided at the end of 2021 to support the allocation of accumulated reserves to alleviate economic pressure on members. This led to last year’s overall 0,45% contribution reduction. At a weighted average of 7,5%, Medihelp’s 2023 increase was also lower than the industry average, providing a very low base for any future adjustments.”

Earlier this year, the Council for Medical Schemes (CMS) recommended that medical schemes cap their contribution increases for 2024 at 5,7%. Yet, none of the medical schemes could accommodate this, especially since medical inflation is about 3% higher than the current consumer price index (CPI) of 4,8%.

Service delivery and product design

Although Medihelp’s commitment to service has been an undeniable differentiator, its products remain the tangible definers of the Medihelp experience. The South African Consumer Satisfaction Index (SA-csi) and the Ask Afrika Orange Index® results demonstrate the combined impact of excellent products and reliable service on a scheme’s member experience.

This was evident during 2023 when Medihelp exceeded the net membership target of 100 000, with 100 198 principal members, over 214 000 beneficiaries, and net organic growth of 6,4%. Medihelp’s membership profile also shows that year-on-year enrolment ages remain younger than the existing membership base; thereby, the Scheme’s average age remains stable.

Medihelp’s product range for 2024 will thus remain as is, offering comprehensive, savings, and vital plans, including:

- An unchanged premium structure where families will continue to benefit from paying for only two babies, toddlers, and teens on MedVital, MedAdd, and MedPrime.
- Child dependant rates will continue to apply to child dependants until they reach age 26, and MedElect will still provide student cover for under R1 000.
- The full basket of preventive care benefits on the vital, savings, and comprehensive plans will remain intact in 2024, as well as the care extender benefit, which has paid out more than R4,5 million in benefits for the year thus far.

In addition, Medihelp will be implementing additional care initiatives in 2024 to support members in seeking the best health outcomes. These include:

- Establishing CoCare Centres of Excellence. It will consist of care baskets for specific procedures that will drive down the overall cost of health interventions. Members applying for pre-authorisation can use this alternative and benefit from fewer out-of-pocket expenses.
- Medihelp will offer a benefit package for treating major depression instead of hospitalisation since, on average, 116 members are admitted to the hospital per month to treat major depression.
- Medihelp will offer members a back and neck rehabilitation programme through Documentation Based Care (DBC). Members will not be liable for co-payments if the DBC treatment programme or alternative treatment is followed and surgery is clinically justified and authorised.
- Medihelp will introduce drug-gene testing or pharmacogenomics to assist high-risk patients in ensuring that the right medication is prescribed for their conditions.
- Currently, 2 195 members are living with high-risk chronic conditions. Medihelp’s disease management programme will be integrated with the Member Zone to assist members in complying with treatment and managing the risks associated with these conditions.

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