Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Profmed to offer better benefits, excellent service in 2011

11 November 2010 Profmed

The Profmed Roadshow detailed to brokers increases in benefits and rates, excellent service performance and the medical scheme’s concerns about the NHI.

In October Profmed, the medical scheme for graduate professionals, took a roadshow to Cape Town, Durban and Johannesburg to launch the new 2011 benefits to its brokers.

Rates and benefits

The roadshow announced the medical scheme’s rates increase, which keeps members’ contributions well below those of other leading medical schemes while maintaining better benefits. The medical scheme has taken things a step further, and has added new benefits at a time when many medical aids are reducing theirs.

“Some medical aids have reduced or changed the benefits that are paid out of savings, thereby reducing benefits ” says Graham Anderson, Profmed’s principal officer. “Profmed does not do this. We are upfront with our members about what their contributions buy them, and will not keep contributions static at the expense of benefits.”

Profmed’s proposed new benefits are before the Council for Medical Schemes, and details will be announced once they are approved.

Service excellence

Profmed also reported that in the last year, the medical scheme’s service levels have been significantly higher than those specified by their service level agreements (SLAs), which are currently set within industry benchmarks.

In September, on average, the processing of new members applications took less than two days, where the SLA stipulates five days. The client services call centre answered 98.7% of all calls, in comparison to the SLA’s mandated 95%, and 92% of calls are answered in under 20 seconds, which is less than the agreed 85%. Finally, claims processing took an average of one day, as opposed to the SLA of a 10-day turnaround.

“We have put a great deal of work into ensuring that we excel at customer service,” says Anderson. “We are cognisant of the fact that we are working with our clients’ money at a time when they are under stress, and we know it is our duty to mitigate that stress, rather than add to it. We believe that these figures bear out our philosophy and intention in this regard.”

Concerns about the NHI

As part of his presentation at the roadshow, Anderson outlined his concerns about the proposed South African National Health Insurance (NHI). “While the proposed NHI is laudable in its intention, in practice there are some very real problems that have the potential to impact on the entire industry,” says Anderson.

His concerns are that the public administration of funds could open the system up to fraud and bankruptcy. At the same time, the projected costs of R128 billion for 2012 would put an incredible burden on the 5 million taxpayers out of a population of 50 million. The projected costs for subsequent years don’t take inflation into account, so the annual increases will be significantly more than projected.

He further explained that individuals on private medical schemes will lose their current tax benefits, so contributions will go up, and there are not sufficient healthcare providers to support the NHI. The proposed importing of foreign doctors and nursing staff is also problematic as they do not have the language and qualifications to work locally, so recruiting them will not solve the problem. In addition, hospitals will be paid less for their services and will need to accommodate more people than before.

“Significant planning needs to go into addressing these concerns before launching an initiative that could be crippling to the industry and ultimately also to the economy,” says Anderson.

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