FANews

Medical scheme cover… just what are clients looking for?

True or false? The biggest amount of complaints from medical scheme members is about waiting times.
Next10.11%

Correct

According to the South African Customer Satisfaction Index (SA-csi) for Medical Schemes (2019), conducted by Consulta, members complain the most about fees and charges (22%), followed by claims (19%), terms of cover or scheme rules (13%), feedback (9%) and waiting time (7%).

 

Incorrect

According to the South African Customer Satisfaction Index (SA-csi) for Medical Schemes (2019), conducted by Consulta, members complain the most about fees and charges (22%), followed by claims (19%), terms of cover or scheme rules (13%), feedback (9%) and waiting time (7%).

 

Next10.11%
The strongest predictors of satisfaction in the medical schemes’ sector is the degree to which members feel that they are treated fairly.
Next20.22%

Correct

According to Professor Adré Schreuder, SA-csi Founder and Chairperson, the strongest predictors of satisfaction in the medical schemes sector is the degree to which customers feel that their healthcare cover provides peace of mind, and their provider delivers as they were led to believe.

Incorrect

According to Professor Adré Schreuder, SA-csi Founder and Chairperson, the strongest predictors of satisfaction in the medical schemes sector is the degree to which customers feel that their healthcare cover provides peace of mind, and their provider delivers as they were led to believe.

Next20.22%
Often members complain about the detail and performance of their cover, the related fees and costs, additional out-of-pocket co-payments, and for claims not being covered, particularly when it comes to chronic medication.
Next30.33%

Correct

According to the South African Customer Satisfaction Index (SA-csi) for Medical Schemes (2019), conducted by Consulta, the reality of the private healthcare system is that it is a minefield for consumers to understand, fraught with industry jargon, complex benefit designs and scheme rules which make direct comparisons onerous, if not impossible at best.  And it is this complexity that leads to customer dissatisfaction as members simply do not fully understand the scope of their cover, and what they are liable for in the event of a claim.  Satisfaction levels for medical schemes are substantially lower than those measured in other financial services industries – one of the key reasons is that the overt complexity of benefit designs does not allow for easy cost versus value correlations.

Incorrect

According to the South African Customer Satisfaction Index (SA-csi) for Medical Schemes (2019), conducted by Consulta, the reality of the private healthcare system is that it is a minefield for consumers to understand, fraught with industry jargon, complex benefit designs and scheme rules which make direct comparisons onerous, if not impossible at best.  And it is this complexity that leads to customer dissatisfaction as members simply do not fully understand the scope of their cover, and what they are liable for in the event of a claim.  Satisfaction levels for medical schemes are substantially lower than those measured in other financial services industries – one of the key reasons is that the overt complexity of benefit designs does not allow for easy cost versus value correlations.

Next30.33%
An increase in the amount of benefit options, within medical schemes sector, has made it easier for members to choose exactly what they want and need.
Next40.44%

Correct

According to the South African Customer Satisfaction Index (SA-csi) for Medical Schemes (2019), conducted by Consulta, the diversity in the choice of schemes has created more complexity, making the advice process more challenging and more specifically, and benefit designs are open to greater risks of misinterpretation by members

Incorrect

According to the South African Customer Satisfaction Index (SA-csi) for Medical Schemes (2019), conducted by Consulta, the diversity in the choice of schemes has created more complexity, making the advice process more challenging and more specifically, and benefit designs are open to greater risks of misinterpretation by members

Next40.44%
Medical schemes are defrauded by service providers, medical scheme members, employees, syndicates, and mostly, by brokers.
Next50.56%

Correct

According to an article, ‘Understanding the types of fraud in claims to South African medical schemes’, published in the South African Medical Journal (SAMJ), fraud committed by medical scheme members encompasses the sharing of medical scheme benefits with non-members (card farming) and non-disclosure of pre-existing conditions at the application stage.

Incorrect

According to an article, ‘Understanding the types of fraud in claims to South African medical schemes’, published in the South African Medical Journal (SAMJ), fraud committed by medical scheme members encompasses the sharing of medical scheme benefits with non-members (card farming) and non-disclosure of pre-existing conditions at the application stage.

Next50.56%
Virtual consultations will happen on a more regular basis. It has been confirmed that all medical schemes will pay less for telemedicine consultations, compared to face-to-face consultations.
Next60.67%

Correct

There is a trend that some schemes will be paying less, but this has not been confirmed as an industry standard.

Incorrect

There is a trend that some schemes will be paying less, but this has not been confirmed as an industry standard.

Next60.67%
Climate change is regarded as the biggest threat to healthcare globally in the 21st century.
Next70.78%

Correct

In a 2014 study done by PWC, climate change was highlighted as one of the biggest threats to healthcare, and therefore, also indirectly to medical schemes. https://www.pwc.co.za/en/assets/pdf/medial-scheme-survey-2014.pdf

Incorrect

In a 2014 study done by PWC, climate change was highlighted as one of the biggest threats to healthcare, and therefore, also indirectly to medical schemes. https://www.pwc.co.za/en/assets/pdf/medial-scheme-survey-2014.pdf

Next70.78%
Did you find the quiz helpful and informative?
Next80.89%

Correct

Incorrect

Next80.89%
What other aspects in the medical scheme sector would you like to learn more about?
Next80.89%

Correct

Incorrect

Next80.89%