"They want a say over what their cover should be and how benefits are used, "writes Alf James
WE BELIEVE IT IS GOING TO TRANSFORM THE INDUSTRY AND CHANGE THE WAY MEDICAL AID BENEFITS ARE STRUCTURED
In a first for the medical scheme industry, Fedhealth has announced its 2019 benefit options, which feature a revolutionary new approach to benefits that provide consumers with more flexibility, choice and control.
According to Jeremy Yatt, principal officer of Fedhealth Medical Scheme, the recent findings and recommendations highlighted in the provisional report issued by the Health Market Inquiry underline the need to change the way medical scheme options are designed.
He says although there is little room to manoeuvre due to legislative constraints, medical schemes should find ways to empower members by addressing their concerns around affordability, transparency and flexibility.
“The inquiry’s provisional report highlights the urgent need for change and it’s time for the medical schemes to step up to the plate,” says Yatt.
Over the past six months Fedhealth carried out extensive research with its member base and the overriding message is that members want to be in control — they want flexibility and they want choice.
“Members want more of a say over what their cover should be, how their daily benefits are used and they don’t want to pay for benefits they are not using,” says Yatt.
“Therein lies the opportunity. There is not one medical scheme in SA that offers that level of flexibility,” he adds.
Based on the research with its member base Fedhealth has developed a range of benefit packages giving members control of their medical aid by offering improved flexibility and choice by changing the scheme’s approach from one of funding to financing.
There are four different benefit packages within Fedhealth’s new FlexiFED range each featuring a core benefit bundle and day-to-day cover, but the most innovative feature of the FlexiFED range is the way members are able to choose to pay for day-to-day benefits.
“Traditionally, up to 25% of the members’ annual contributions have been placed in a medical savings account (effectively as a loan) which was used to pay for day-to-day benefits,” explains Yatt.
“For the first time, Fedhealth has turned this model around. FlexiFED allows members to begin paying for day-to-day benefits only when they need them. When they access this funding will they have the flexibility to pay back that amount over 12 months, interest free. At a time when most consumers are struggling to make ends meet, this can make a meaningful difference to their financial position. This is a significant departure from how other medical schemes in SA manage their medical aid savings accounts.
“Traditionally members have been charged for day-to-day benefits from the beginning of the year regardless of whether they have seen a doctor or purchased medicine or not.
“Fedhealth is now the only medical aid to offer members a significantly reduced monthly rate by introducing the MediVault and Wallet.
“Based on their unique profile and the core benefit bundle they select, a preapproved amount is placed in the member’s individual MediVault at the beginning of the year. This amount is not pro-rated and works the same as a traditional savings account, except that members only pay for it once they use it.
“When the member needs to pay for day-to-day expenses, they simply transfer the funds they need from their MediVault into their Wallet and only then start paying back those funds, without having to pay interest,” says Yatt.
“When it comes to medical aid, we know price is one of the most important considerations for members.
“We worked hard to find innovative ways to save members money and provide them with the benefit of added choice. Our solution has been to offer four core benefit bundles, specifically tailored to different lifestyle requirements and which can be personalised even further to suit individual needs.”
Yatt says the flexiFED 1 benefit bundle is perfect for healthy, young single people looking for affordable, quality cover. Personalised benefits like trauma treatment, unlimited accident and emergency treatment and female contraception have been added.
FlexiFED 2 is more suited to young families starting out and this option is now rich in maternity benefits and some great lifestyle and childhood benefits. FlexiFED 3 has been tailored to young families making their way up in the world and also includes rich maternity, lifestyle and childhood benefits for families who are still growing.
Finally, flexiFED 4 has been designed for more mature families looking for all-inclusive cover. Personalised benefits like specialised radiology, child rates up to the age of 27, unlimited network GP consults from core benefit bundle and unlimited private hospital cover for planned procedures are just some of the features offered.
All core benefit bundles come pre-packed with valueadded benefits covered from Risk, not from the MediVault and Wallet.
Fedhealth has introduced a “benefit maximiser” to boost the above benefits. On flexiFED 1, 2 and 3 it covers unlimited network GP visits and dentistry benefits even after a member’s MediVault and Wallet has been depleted. On flexiFED 4, claims can be submitted to accumulate to a predetermined threshold level, after which they will be paid from the benefit maximiser with a 20% co-payment on all claims.
The final benefit for members is that they have the flexibility to choose to control their own rates. Once they have selected their core benefit bundle they can personalise their options and create the package of benefits they need at a price they can afford.
“Members save 11% of their contribution by selecting the Network Hospital Option (GRID) or they can save 25% by limiting themselves to a smaller hospital network or just by paying an R11,500 excess for planned procedures at a hospital of their choice. The important thing for members to remember is that in the event of an emergency or accident they can still use the private hospital of their choice.
“FlexiFED represents a new approach. We believe it is going to transform the industry and change the way medical aid benefits are structured in the future,” says Yatt.
Fedhealth also proposes to redouble its efforts to educate members. “There are a number of claims trends which can be curbed through consumer education,” says Yatt.
“There is an increasing incidence of members opting, as their first course, to visit an expensive specialist when a general practitioner would more than suffice. Lifestyle diseases such as diabetes and heart disease are rampant.
“Underpinning our innovation is the desire for people to take charge of their health and their finances — but also to educate people who irresponsibly abuse their health.
“With our ‘financing’ model, as opposed to the traditional ‘funding’ model, there remain financing options whereby an individual can set aside money for a health catastrophe — either by saving the money for it, or by borrowing and repaying.
“We have cracked the mould by developing a mechanism whereby members can access a type of financing when they need it, but don’t have to fork out money if they don’t. This is a huge departure from how other medical schemes in SA currently manage their medical aid savings accounts,” says Yatt