Medical schemes: giving more than they are taking in 2021?

Categories: Care, Community Engagement, Featured, and Policy.

When medical aid schemes recently announced their increases for next year, consumers cynically wondered whether they will have to give up some benefits to make up for the small increases, but it looks like they will not have to.

Jeremy Yatt, principal officer of Fedhealth, says the scheme announced a slightly higher increase for 2021 than the rest of the industry, but at the same time ensured that absolutely no benefits are cut in order to reach a lower increase.

“Fedhealth believes that it is more important during these difficult times to ensure that members have sufficient cover. Members can therefore rest assured that they will have exactly the same benefits or more as in 2020,” says Yatt.

Bonitas Medical Scheme’s contribution increases for 2021 range from a 0% increase on the BonFit Select plan, to a weighted increase of 4.6% across all plans. The highest increase is 7.1%. Certain member benefits have been restructured for the year ahead.

“Some benefits have changed to reflect our focus on primary healthcare, utilisation of preventative care benefits, digitally enabled solutions and self-help facilities for members who want access to their benefits 24/7. Our goal is to improve integration of care, enable more access to out-of-hospital services, clinical information and benefits via various solutions,” Bonitas says.

Key changes include two new products introduced under “Edge” for economically active singles or couples in the larger metros, increased focus on managed care protocols, virtual care, palliative care, home care and more day hospital or clinic procedures.

Bonitas is also adding a mental health resource hub and app. Other changes are that members only pay for three children, access to more benefits after completing a wellness screening check, cover for up to 60 chronic conditions and a maternity programme.

Momentum Health Solutions did not restrict any benefits or options for 2021. “We aimed to keep the benefits similar to the previous year to help members retain similar cover. This is critical in a health crisis. We did not make any negative changes to benefits. Benefit limits were also increased with inflation where applicable,” says Damian McHugh, executive at Momentum Health Solutions.

He says member benefits were not impacted negatively by the smaller increase. “We believe that in the most difficult year for consumers we should offer benefit security and do that with the lowest possible benefit increase.”

Bestmed’s annual average increase for 2021 is 4% and for the second successive year, Bestmed has no benefit cuts or reductions. All limits and sub-limits were increased by 5% across all benefit options. In-hospital benefits include palliative care and home-based care instead of hospitalisation and day procedures will be funded at day hospital rates.

Out-of-hospital benefits include separate benefit limits for hearing aids and preventative care will cover certain mandatory travel vaccines, while antenatal supplements will be available for members registered on the maternity care programme. Mammograms have been added for members over 40.

Medshield announced a 5.9% weighted contribution increase for 2021 and a 6% benefits increase on selected benefits across all Medshield benefit options. “There are no benefit reduction only enhancements for 2021 across all options,” says Thoneshan Naidoo, principal officer of Medshield.

Discovery announced that there will not be an increase to contributions for all Discovery Health Medical Scheme members across all plans for the first six months of 2021.

“Discovery is mindful of and sensitive to the financial pressures facing individuals at this time within the country’s stressed economic climate. This contribution increase of 0% is also in line with the expected medical inflation during the January-June 2021 period,” says Deon Kotzé, head of research and development at Discovery Health.

He says members will have access to the same benefits, while benefits have been updated and enhanced to enable a broader range of digital healthcare services for members, drive positive healthcare outcomes for members and increase affordable access to healthcare.

Benefit changes include access to cutting-edge, digitally connected care as well as connected care at home, cutting-edge technology to optimise care for chronic conditions and optimising acute care at home. On-going improvements to mental wellbeing support systems, a Shari’ah-compliant arrangement, cover for infertility treatment, a diabetes care programme and an expanded day surgery network will also form part of the benefit changes.

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