Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Three trends in medical scheme membership as we move towards 2021

11 November 2020 Nerine Brink, Principal at PSG Wealth R21 Employee Benefits
Nerine Brink, Principal at PSG Wealth R21 Employee Benefits

Nerine Brink, Principal at PSG Wealth R21 Employee Benefits

It’s that time of year again – and we’re all looking ahead to ensure we are adequately covered for our medical needs in the months to come. Members of medical schemes offered as part of their employee benefits are under as much pressure as anyone to make ends meet, in light of the economic strain COVID-19 has caused.

It’s not an easy choice to get right without a knowledgeable adviser by your side, however, and it’s especially interesting to see how the ‘new normal’ has impacted medical scheme benefit choices. Here are three trends we’ve seen emerge so far.

1 - Medical scheme benefits – two camps

We find that members are following one of two patterns when it comes to selecting their 2021 benefit options. They are either decreasing their benefits drastically to reduce the cost of cover as much as they can, or they are comfortable to pay for more enhanced benefits, which is particularly true when it comes to day-to-day cover.

Why a drastic decrease in benefits is an ill-advised choice

Some members seem to completely disregard the possible shortfalls on future medical events or expenses they might face, in order to save on premiums now. Many members are aware of the options available to them, such as that they can reapply for comprehensive medical scheme benefits without the fear of underwriting (albeit during a certain period).

Why keeping cover consistent counts

Members who are happy to keep cover in place, or even pay for better benefits, tend to go through these benefits in detail to justify the increase in premium. This helps them better understand the benefits and how to use the product as efficiently as possible. These members are inclined to take out a gap cover product and reduce their in-hospital reimbursement rate, providing them with greater in-hospital benefits (with a bit of additional administrative work via the gap cover claiming process), while also reducing their premiums.

2 - Benefit consultations beckon

Employer groups are accustomed to having onsite consultations for the employees who need to review their benefits. Due to COVID-19, safety policies promote virtual consultations and most intermediary practices have adapted to provide this functionality, or to offer a hybrid of both virtual and onsite appointments.

Some health and safety conscious employers have blocked any third parties from entering the premises to ensure the risk of infection is limited. Meanwhile, other employers whose employees do not have access to a computer, continue with onsite consultations, as there is no other option.

Most members who have computer access with internet connectivity prefer virtual consultations for reasons including the ease of access and the dedicated interaction this one-on-one format provides. One-on-one consultations with seamless live booking functionality, enables members to choose a date and time that suits their schedule best. Even though onsite consultations provide for a dedicated session, it is the additional privacy provided by conducting the consultation via a virtual platform that appeals to members. Some members are also at higher risk now than others, so virtual capabilities have contributed positively here as well.

3 – Referrals reducing risk

More employers are opting in for a referral process when it comes to general practitioner (GP) benefits, to mitigate risks. The referral process assists employers in reducing the number of unnecessary sick days taken by adding an additional step where a pattern of absenteeism has been noted. While employees retain their ability to access quality medical care, the employer is also protected by managing absenteeism in a responsible manner.

Employers are trying to keep costs as low as possible for employees who are on a compulsory medical arrangement, regardless of whether this is provided on a cost to company arrangement or in the form of a subsidy. A referral process reduces the costs of membership as it lowers the risks to the insurer.

It’s important to work with an employee benefits adviser who can help you in finding the right scheme for your company’s needs. They can provide guidance in managing affordability, selecting an option that offers the most comprehensive benefits and ensuring sustainability for both the members of the medical scheme and the employer. Members of medical schemes deserve one-on-one consulting options too, because they need proper understanding of their own benefits to get the most out of their membership. The recent pandemic has highlighted again how important it is to have the right medical cover in place, so be sure to seek the help of a suitably qualified adviser and ensure your choice is optimally aligned to serve your employees’ needs in the year ahead.

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