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Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Your health – one of the most important investments you’ll ever make

04 July 2012 Medihelp
Anton Rijnen, CEO of Medihelp

Anton Rijnen, CEO of Medihelp

“Funny how little thought and research goes into the average person’s choice of a medical scheme compared to the time and effort he or she puts into making a purely financial or other investment”, says Anton Rijnen, CEO of Medihelp, South Africa’s third l

“It’s time for people to realise that an investment in their health is just as important as any other investment in their portfolios. In fact, an investment in your health is probably the most important long-term investment you can make, especially for the family as a whole,” he says.

The first step towards peace of mind for an individual or a family is choosing a medical scheme. There are several general factors which are important to consider when choosing a medical scheme.

Size

In today’s competitive healthcare environment a medical scheme should be big enough to negotiate with all the role players in the industry on a variety of topics which would eventually benefit the member. A larger number of members usually result in more affordable membership fees, not only because members subsidise one another, but also because the scheme is able to negotiate better prices with large service provider groups.

Financial stability

A financially healthy scheme gives members the reassurance that their claims will be paid. The Registrar of Medical Schemes therefore requires all medical schemes in South Africa to have a solvency level of 25% or higher. In short, a healthy solvency level implies sufficient reserves, which means sufficient funds to pay claims, also in times of crisis.

Administration capability

Rijnen says despite a scheme’s size and solvency it is still possible that members find they have to bear the brunt when it’s time to submit a claim. “This is because of the administrative processes involved in assessing the claim. A scheme must be able to receive volumes of claims, preferably electronically, and process these in record time. This ensures convenience for members and service providers. The inherent cost of the administration process for the member is also an important factor,’ he says. The Global Credit Rating Company rates schemes’ overall claims paying abilities and can be used as a yardstick of performance by prospective members.

Client service

“Because the healthcare industry is moving towards an environment where medical scheme products basically offer the same benefits with only minor differences in premiums, we find that client service is becoming an ever more important distinguishing factor when it comes to the choice of a scheme”, he says.

Benefit options

In the past, people simply chose the benefit option offering the most comprehensive coverage because they wanted to be covered for ‘everything’. But the most comprehensive option is also the most expensive one, and with every annual premium increase it becomes more expensive, until the member can no longer afford the option and decides to leave. “The trick is to choose an option which suits the specific needs of the individual and the family. A good scheme usually offers a choice of options which make provision for specific needs”, says Rijnen.

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