Medical Aid Premium Increases 2014
Discovery Health, the largest open medical aid scheme and the seventh biggest overall in South Africa, has announced that the average member contribution will be 8,9 per cent higher next year. The raise will be applicable to all of the almost two and a half million Discovery members,
Fedhealth increases will range from 7,9 per cent to 9 per cent. Fedhealth has just more than a 152 000 members.
In the meantime, KeyHealth, one of the smaller schemes, also announced that their member contributions will rise by 8,9 per cent.
DISCOVERY SAYS IT’S COMPETITIVE
Doctor Johanthan Broomberg, the Chief Executive Officer of Discovery Health said that the increases announced by Discovery is among the lowest in the country, at least 15% lower than any other medical aid scheme. He conceded, however, that his statistics are only valid regarding open schemes.
The Discoverer, a newsletter published by Discovery Health said that all members and their dependents pay eleven rand forty three per month more for administration fees than the fee charged by any other scheme. To compensate for this higher fee, members are charged almost a hundred and sixty rand per month less for contributions.
The newsletter also announced that Discovery will be lowering the limits currently in place for chronic condition medication because the price of such medicines has decreased. This decrease is due to negotiations between Discovery and various pharmaceutical companies. The lower limits will be introduced by the middle of next year.
ALEXANDER FORBES GIVES MORE DETAILS
According to Alexander Forbes Healthcare deductibles, co-payments and limits will remain constant for certain scans, specialized medication, oncology treatments and hip and knee prostheses will remain constant. All other benefit options will be increased with eight point nine per cent, however. At the same time, limits for surgical devices will be increased by six per cent.
Alexander Forbes further revealed that the threshold levels of the Discovery Executive, Priority and Comprehensive plans will all be increased by 8,2 to 10,2 two per cent.
DISCOVERY DELTA DEVELOPMENTS
All members of Discovery’s Delta plans will have to make use of a newly appointed service provider, MedXpress, for their chronic medication. Failure to do so will result in a demand for a twenty per cent co-payment by members.
The Discoverer went on to say that benefits related to the care of terminally ill members have been enhanced by thirty per cent. Benefits will forthwith also include therapies and treatments for pain relief, nursing, support and hydration. At the same time there will be additional benefits for pregnant women. It will now be possible to access antenatal consultations and even scans, as long as the approved network of service providers is utilized.
These additional benefits will only become available if the relevant medical savings plan is depleted.
Another change is that Discovery has appointed an approved supplier for costly devices such as wheelchairs. Members that prefer models other than those offered by the preferred supplier will have to pay the difference themselves.
MORE INFO FOR DISCOVERY MEMBERS
There are other changes. Discovery members must take note of the following:
• The scheme gas compiled a list of preferred medication for a wide range of acute conditions (not to be confused with chronic illnesses). This list includes both original and generic brands. When members of the Classic, Classic Delta Comprehensive, Comprehensive and Executive plans have depleted their medical savings accounts, they will automatically gain access to the medicines on this list. Such members will also be able to undergo blood tests from approved pathologists.
• Discovery has introduced a new-look wellness program. These wellness benefits are offered to companies that choose Discovery as their medical aid scheme for their employees. The wellness program includes benefits such as a range of preventive treatments, access to health related information and regular reports on the general health of members. Discovery will also advise on the development of corporate wellness strategies.
Fedhealth has also introduced two new options related to their Maxima range of plans that are primarily aimed and young members. Both these options (Maxima Entrysaver and Maxima Saver) offer hospital cover. Entrysaver members will be restricted to an approved network of hospitals, however.
At the same time, Fedhealth has scrapped the Ultima 300 plan. This was the most comprehensive option in their stable of products. Members will automatically become members of the Maxima range of plans.
Alexander Forbes has also revealed that the limits imposed by Fedhealth as well as the co-payments have increased by six per cent.
The principal officer of Fedhealth, Peter Jordan, said that their network of service providers has grown to four thousand four hundred general practitioners and three thousand four hundred specialists. Jordan reiterated that the network is useful in ensuring that members enjoy comprehensive benefits without having to pay for a portion of the services rendered. He added that Fedhealth cash reserves have grown to thirty eight per cent – twenty five per cent more than the legal requirement.
The cash reserves of Discovery stood at almost twenty three and a half per cent by the end of 2012.
Jordan says that at the end of July Fedhealth’s reserves stood at 38 percent – above the 25 percent required by law.