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Hybrid scheme’s fresh approach boosts benefits

Sophisticated benefit design that puts medical scheme members in control of their healthcare while providing one of the strongest value propositions in the market has enabled Health Squared Medical Scheme, the result of a merger between Resolution Health and Spectramed medical schemes, to implement single digit contribution increases and an array of benefit enhancements for the coming year.

The scheme’s industryleading hybrid options coupled with its pioneering Agility Rewards Platinum programme with unique cash-back rewards incentives, which enables members to earn up to R37,900 back in rewards, is setting a new standard in affordability and value within the healthcare funding industry.

“Health Squared offers the industry’s most potent affordability and value proposition, which integrates with the Agility Rewards employee wellbeing and financial services products ensuring exceptional value to individuals and employer groups,” says spokesperson Bianca Viljoen. “In terms of option-specific contribution increases for 2020, we have worked to ensure members benefit from some of the lowest increases in a decade.”

The scheme announced a weighted average increase of 9.8% for 2020, which translates to as little as 3% on some of its benefit options.

Members who subscribe to Health Squared’s exclusive Agility Rewards Platinum can choose to offset their contribution increases through reinvesting their cash-back rewards, Viljoen explains. The programme enables families to earn up to R37,900 per year for simple, achievable healthy lifestyle choices. Members are rewarded for gym exercise, fitness programmes, school and university fees, flights on any airline, routine health screenings and participating in sporting events, to name but a few examples.

“Across all options, we have implemented a 4.5% increase in benefits on categories of cover, as well as additional maternity scans and other option-specific enhancements. This means our 36,628 beneficiaries are more than recouping their annual membership fees in terms of the richness of the benefits they are entitled to.”

The scheme’s contribution increases, she reveals, were primarily driven by healthcare inflation, which routinely outstrips annual consumer price index inflation. For 2020, those enrolled on Health Squared’s Rise capitation plan will see the principal member’s contribution increase by 5%, with no increase implemented for adult or child dependents.

“Amid an industry-wide trend where medical scheme members are looking to reduce costs, individuals and families are looking for true, quantifiable value from their cover. Given conventional approaches to the provision of healthcare cover, we are increasingly finding members want more bespoke cover that affords them greater control over their healthcare benefits,” says Viljoen.

“Employer groups are looking for the flexibility to provide cover for all levels of the workforce, from executive level to semiskilled staff, as well as value-added rewards that holistically support health and wellbeing.”

She says the scheme is addressing these market-driven needs through an ideal mix of traditional, new generation and hybrid model benefit options, representing a wealth of choice for members and corporates.

  • source MAMM clips | Business Day

Combining technology with the human touch

Digital innovations have the potential to lower barriers to access high-quality private healthcare

THE INTENTION BEHIND SMARTCARE IS BASED PURELY ON ACCESS AND CONVENIENCE WITH A GOOD PRICING BENEFIT

Medshield Medical Scheme recently launched an innovative benefit which combines cutting edge healthcare technology with a human touch.

The scheme’s SmartCare offering provides members with access to nurse-led primary healthcare consultations and Videomed doctor consultations from enabled pharmacies and clinics. Balancing affordability with high quality healthcare and convenient access, Medshield is the first medical scheme in SA to offer this service as a benefit for all members, at no additional cost, says Medshield’s principal officer Thoneshan Naidoo.

While SA has generally been slow to embrace the fourth industrial revolution in healthcare, Naidoo believes that innovations such as Medshield’s SmartCare offering will bridge the digital healthcare gap in SA and pave the way for increased adoption of telemedicine and for accessible healthcare services. “Technology has the potential to lower the barriers to access high quality private healthcare and conveniently save our members precious time in their busy schedules,” he says.

Videomed is designed around the experience and capabilities of registered nurses operating from pharmacy clinics. A nurse completes the initial patient examination and, if necessary, calls a doctor into the consultation via a real-time video connection. The doctor is able to see all the investigations and examinations conducted by the nurse, and can provide a diagnosis and prescription where required. Videomed general practitioners are fluent in 10 of SA’s official languages and have special interests in a range of disciplines including paediatrics, family medicine, geriatric care, anaesthetics, rheumatology, drug rehabilitation, orthopaedics and pain management.

Not only does SmartCare allow Medshield members to stretch their benefits but also to access healthcare providers after hours and over weekends without an appointment.

“Our members love the Medshield SmartCare value proposition and in 2020 we are enabling unlimited SmartCare nurse consultations across all our plans,” says Naidoo.

He points out, however, that SmartCare doesn’t replace the need for general practitioners, but will create new opportunities for referrals to local GPs. “The intention behind SmartCare is based purely on access and convenience with a good pricing benefit.”

Affordability is becoming a significant issue for many medical aid members, he concedes. While healthcare inflation is significantly higher than general consumer inflation, Medshield has found innovative ways to offer its members value, which includes the introduction of the Prime and Compact networks on its MediPlus and MediValue plans.

“Through our Prime and Compact networks members are empowered within their plans: they can benefit from a 0% increase on our Compact networks by following the healthcare provider networks and rules specifically designed for their access.”

Other new products being introduced include MediCurve, an affordable plan which has been specially designed with younger, digital savvy members in mind. The plan is largely driven via a mobile app.

Medshield, a not-for-profit medical scheme, uses 90% of member contributions to pay claims. “New technologies and new medications have had an impact on medical inflation which has informed our increases for 2020,” says Naidoo. “However, we believe our products are about 20% cheaper than the industry average when taking into account the richer benefits we offer. At the lower end of our plan range we’ve managed to avoid a contribution increase while at the more affluent upper end there is a 12.5% increase with an effective risk contribution of 8.5%.”

With the advent of technology and easy access to information, members are becoming more financially savvy and conscious of deriving value for money from their purchase. To compete, medical schemes must innovate and adapt to cater to these consumers.

As part of Medshield’s enhanced value proposition it has collaborated with partners Just Rewards and Elevate to offer a Freemium loyalty programme benefit which provides free legal advice and a fuel rebate at Shell garages as well as rewards for living a healthy lifestyle. Members can also select the Premium Loyalty Programme offering and receive discounts on gym memberships and from grocery retailers, twofor-one dining options and tailored financial services.

“As a scheme we are well capitalised with R1.7bn in reserve and have recently been reaccredited as AA- by the Global Credit Ratings Agency. We’ve taken a conscientious decision to use part of our high solvency to unlock better benefits for members,” he says.

Naidoo is cognisant of the need for schemes to cater not only for those who can afford it but also the additional seven to 14-million South Africans who use private healthcare on a cash basis.

“Good healthcare is not just for the affluent and those who can afford it. Everyone deserves this privilege,” maintains Naidoo.

Medshield is creating a platform where all South Africans have access to quality healthcare. Pending regulatory approval from the Council for Medical Schemes, it’s looking to launch a MediAlpha plan, a series of low-cost benefit options starting at R130 per month that will enable access to private primary healthcare to millions of uncovered South Africans who have not traditionally been able to afford medical cover.

MediAlpha, says Naidoo, is motivated by a social mandate to ensure quality primary healthcare is more easily accessible to more people.

  • source MAMM clips | Business Day

Opt for gap cover to cover shortfalls

Typically the most common medical expense shortfalls relate to hospital admissions.

In these instances the member may have to pay the difference between what their specialist charged and what their scheme paid for their inhospital treatment, or for consultations and treatment in the period prior to and after the admission, according to Deon Kotze, head of Research and Development at Discovery Health, the administrator of Discovery Health Medical Scheme.

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  • source MAMM clips | Business Day

Schemes battle costs to remain sustainable

SA operates a two-tiered healthcare system: a free public healthcare sector and an expensive, but better quality, private sector.

There are 75 medical schemes in SA, consisting of both open and restricted medical schemes. Medical schemes are regulated by the Council for Medical Schemes, a statutory body which provides regulatory supervision of private health financing through medical schemes.

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  • source MAMM clips | Business Day

Members’ expectations not being met, according to index

Medical schemes are largely failing to impress consumers when it comes to customer satisfaction. According to the South African Customer Satisfaction Index, conducted by Consulta, there is no one scheme that has clearly differentiated itself in terms of customer satisfaction.

The index provides insights into the overall level of satisfaction of members of SA’s major medical schemes and is the only independent benchmark of customer experience in this sector. Consulta polled 1,707 medical scheme members across five of the leading schemes by membership numbers.

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  • source MAMM clips | Business Day

Debate around funding, workings of NHI rages on

What is unclear is the precise role of medical schemes under this service

THE WEALTH OF DATA, EXPERIENCE AND EXPERTISE THAT EXISTS IN THE PRIVATE SECTOR SHOULD BE BUILT ON RATHER THAN DISCARDED

There continues to be significant uncertainty and huge debate around the government’s proposed National Health Insurance (NHI), particularly exactly how it will be funded and how it will work in reality given the state’s poor track record in managing the public health sector.

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