Profmed has low increase, enhanced benefits for 2012

In 2012, Profmed members will enjoy extremely low increases in contributions on all options, while at the same time experiencing increases in benefits.

For existing members of Profmed, the medical scheme for graduate professionals, the contribution increase in 2012 will be only 6.8% (averaged across all options). The increase was kept at a minimum by the effective management of the scheme and no benefits were reduced to enable this. In fact, certain benefits have been added, such as the inclusion of in-hospital dental benefits on Profmed’s hospital cover options, and the reduction of the child contribution ratio by 5%.

In 2012, Profmed members can enjoy the following:

• Unlimited hospital cover with no copayment or deposits on admission
• 300% cover on three of the five options
• New in-hospital dentistry benefits on ProActive and ProActive Plus options
• The majority of benefit limits and tariffs have been increased in excess of CPI.

“Profmed is here to provide a service to its members and we are constantly looking for ways to improve and enhance that service,” says Anderson. “We believe that the added benefits, low increase and reduction in child contributions go a long way to achieving this.”

Excellent service, all the way

In addition, Profmed’s service levels were consistently significantly better than the service level agreements (SLAs). In August 2011, the average processing of new members took 2.3 days, while the SLA states five days, call centre agents answered 98.9% of all calls while the SLA states 95%, and the processing of claims took one day on average compared to an SLA of 10 days.

“We’re one of the few medical schemes willing to publish our service levels because they’re so high,” says Anderson. “I’m always extremely proud of the work that we do in this area.”

Growth potential

Profmed was one of a handful of medical schemes that experienced net growth in 2009, continuing through 2010 and 2011, and Graham Anderson, principal officer of the scheme, believes that they will experience further growth in 2012.

He attributes this growth to the health of Profmed as well as the scheme’s benefits being extremely appealing to members. “I believe that we continue to grow because of our excellent service levels, our good reserves, the fact that we make an operating profit so don’t use our investment income to pay our claims and that we offer excellent benefits.”

Response to the NHI

It has been a year of upheaval and scrutiny for the medical scheme and healthcare industries in South Africa. One issue that has claimed many headlines has been the proposed National Health Insurance. All taxpaying citizens are watching the story unfold to analyse how it will affect them, their healthcare and their medical scheme.

Anderson says that this restructuring of the public health system to establish a single-tier health system as a priority above all others will doubtless have an impact on the industry, but that at this stage a very broad proposal is all the information that has been released by government, so it is not possible to come to a conclusion about how this will affect medical schemes in the short to medium term.

At the same time, a phased roll-out will be implemented, so any changes are still a number of years off – and multiple scenarios could yet unfold. “The short-term impact on medical schemes is limited; the long-term impact could be fundamental,” says Anderson. “There is opportunity for medical schemes to comment under the consultative phases, and hopefully a solution will be found that doesn’t overburden the taxpayer while decreasing their access to quality healthcare. We will certainly be encouraging that.”

About Profmed

Profmed is the largest restricted medical scheme in South Africa, serving a growing base of 26 000 graduate professionals.

Profmed focuses on providing premium medical cover and health management services with extensive benefits to match the professional lifestyle. The medical scheme prides itself on providing exceptional benefits while remaining committed to competitive contributions and service excellence.

The scheme offers unlimited hospital cover, lowest student rates and comprehensive dread disease cover.