Healthcare / Medical Schemes

Medical schemes in uncharted territory

Actuaries at South Africa’s large open medical schemes find themselves in uncharted territory as they set about forecasting members’ benefits utilisation for 2022 and beyond. The data gathered over the decade ending 2019 has been rendered practically obsolete due to the significant shifts in medical schemes’ claims patterns coinciding with lockdown levels and successive waves of Covid-19 infection. To further complicate matters, a detailed assessment of Momentum Medical Scheme (MMS) 2020 and year-to-date 2021 statistics, shows little evidence of the expected rebound of hospital admissions to pre-lockdown levels.

Understanding medical aid waiting periods

New members applying to medical aid schemes need to understand that there is a waiting period before they may claim. They pay full contributions to the medical scheme during this waiting period, but cannot yet claim for full benefits from the scheme.

Covid hub drives education and vaccination

Maximise Prescribed Minimum Benefits

Thinking about medical aid is enough to give anyone a headache. The jargon, T&Cs and the dreaded co-payments. One term that all medical aids undoubtedly use is Prescribed Minimum Benefits (PMBs), but it is another grey area that many people are not too clued up on.