Tag Archive for: Medical Aid

Andrew Stegmann

COVID-19: Make Sure Your Medical Aid, Savings, and Risk Benefits are Covered

The Covid-19 pandemic has placed additional financial pressure on South Africans. If you are being retrenched or having your hours cut, you might be pondering your options on pausing or cancelling retirement fund or medical aid payments.

Pension and provident fund payments

Pension and provident contributions shouldn’t be stopped as long as you are paid an income, as they are based on your salary. If you are not receiving a salary, then no contributions will be deducted and the lockdown shouldn’t affect your contributions. If your salary is reduced during the lockdown, your contributions will also be less because they are a percentage of your salary.

Even if contribution rates can be changed on a fund, this can usually only happen once a year, or as set out in the rules of your retirement fund.

Retirement annuity payments

With regard to retirement annuities (RAs), older policies could have a penalty when you make your policy paid up, as it recoups upfront advice and set-up costs over the period of your policy. New-generation RAs are more flexible normally, as the broker is only paid as and when and it is likely that you can stop the premium without incurring penalties and then just restart the contributions once your cash flow is better. You can’t access the RAs accumulated values until retirement age.

Risk insurance policies for death and disability cover

Your risk insurance policies covering death, disability and other associated benefits are important to maintain during this time. If you are experiencing financial difficulties in funding this cover, chat to your financial adviser to help with discussions with your underwriter to determine if they have any temporary relief strategies in place during this time. This cover is essential for you and your dependents in the event of claim.

Medical aid payments

Covid-19 is a prescribed minimum benefit, and while it is understandable that many medical aid members will consider cancelling their medical scheme membership as a result of financial pressure from Covid-19, they will be able to access private healthcare should they require hospitalisation because of the virus.

Recently the Council of Medical Schemes issued a circular to confirm that all schemes are to regard Covid-19 as a prescribed minimum benefit and pay for the diagnosis and treatment of this condition in full as required by the Medical Schemes Act irrespective of plan type or option. This is to include the costs of all consultations, diagnostic tests, appropriate medication and hospitalization.

  • Buying down
  • Reducing the number of dependents
  • Consider the consequences of cancelling your membership.

For information about COVID-19 in South Africa, visit the Department of Health’s website here, and for general COVID-19 information, visit the WHO’s website here.

For information as to how Relocation Africa can help you with your Mobility, Immigration, Research, Remuneration, and Expat Tax needs, email info@relocationafrica.com, or call us on +27 21 763 4240.

Sources: [1], [2]. Image sources: [1], [2].



Andrew Stegmann

Major South African Medical Schemes, and What They Offer

A new year brings higher prices and some big changes to South Africa’s medical aid schemes. Below is what the five biggest schemes in the country have on offer for 2020 – and how much they’re charging.

South Africa is home to 80 different medical aid schemes, with 4.02 million registered members, serving a total of 8.87 million beneficiaries.

Among these schemes, 21 are open schemes (that anyone is free to join) and 59 restricted schemes (for companies, or specific sectors or industries).

The largest scheme by some margin is Discovery Health, which has 1.335 million members (33.2% of the total) and 2.79 million beneficiaries (31.5% of the total).

Among the open schemes, Discovery is followed by Bonitas, with 331,955 members and 713,190 beneficiaries, and Momentum Health, with 156,761 members and 298,071 beneficiaries.

This is followed by BestMed (93,635 members and 197,088 beneficiaries) and MediHelp (92,884 members and 201,944 beneficiaries).

Medical aid users would have noted price increases across all medical schemes in 2020 – though some schemes have raises prices more than others.

Discovery’s medical plan increases ranged between 9% and 11%, while Bonitas saw an overall weighted increase of 9.9% among its schemes. Momentum’s weighted increase was 8.2%, and BestMed saw price increases of 8.9% among options.

MediHelp’s price increases average at 11.9%.

What’s the same

By law, South African medical schemes are non-profit trusts, owned by their members. In this sense, they are all functionally the same – members’ contributions are pooled and used to pay relevant medical costs where necessary, while keeping a legislated surplus to prevent the scheme from collapsing.

Some medical plans have a savings option, which creates a savings pool from a member’s monthly contributions which is for exclusive use by that member.

Medical aid schemes are also required by law to cover a set list of chronic illnesses, known as the Prescribed Minimum Benefits (PMB). This is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected.

Beyond this, medical aid schemes are free to differentiate themselves through their product offerings, usually targeting specific demographics.

Things like annual limits, specialised benefits, family cover, day-to-day coverage and networked doctors and hospitals all vary across the different plans – both internally across a single group’s plans, and from company to company.

This article not a comprehensive review of each individual plan offered by the medical aids, and if you’re looking to change schemes, upgrade or downgrade, you should read through the information provided by the respective groups to ensure your health needs are covered.

Discovery

  • Offers 29 plans Across 7 scheme categories.
  • No overall limit for hospital cover on any Discovery Health Medical Scheme plan. You can go to any private hospital on most plans;
  • Access to screening and prevention benefits that cover tests to detect early warning signs of serious illness;
  • Above Threshold Benefit (ATB) that gives further day-to-day cover once the Annual Threshold has been reached;
  • Day-to-day Extender Benefit (DEB) for essential healthcare services in its network once medical savings are used up;

In 2020 Discovery said that co-payments and deductibles will be increased by 9.5%. It added that benefit limits will be increased by 9.5% with the exception of things like the oncology threshold, international travel benefit, among others, where there is no increase for 2020.

From 1 January 2020, certain formulary changes and chronic drug amount updates will be applied, and the the Day-to-day Extender Benefit will now cover video call consultations with a network GP as well as pharmacy clinic consultations in the group’s wellness network. More information on the major Discovery changes can be read here.

One of the biggest changes to Discovery in 2020 is the Vitality programme – more specifically, the Vitality Rewards Points, which will be converted into the group-wide Discovery Miles.

You can read more about the changes being made to the Vitality points system here.

Bonitas

  • Offers 13 plans across 9 scheme categories.
  • Cover for 27 to 60 chronic conditions and free medicine delivery;
  • Free cover for your fourth and subsequent children so you only pay for a maximum of three children;
  • Has Managed Care programmes to help manage chronic conditions including cancer, mental health, HIV/AIDS and diabetes;

Key changes for Bonitas in 2020 come by way of enhances maternity benefits and support, additions to the Wellness Extended benefit, the introduction of a pharmacy network, as well as changes to co-payments and hearing-aid cycles.

Currently the Wellness Extender benefit can be accessed after competing a wellness screening test. It can be used for consultations and treatment with a GP, physiotherapist, dietician or biokineticist, or to participate in a stop smoking programme. In 2020, the benefit will be extended to include blood tests and x-rays.

With the new pharmacy network, members will be able to access chronic, acute, over-the-counter and oncology medicine from a network of providers which will avoid having to pay additional dispensing fees.

Expecting mothers will gain access to lactation specialists, and also get major discounts from Baby City, as well as a mother and child support network.

A full breakdown of the major changes to Bonitas for 2020 can be found here.

Momentum

  • Offers 35 plans across 6 scheme categories.
  • No overall annual limit for hospitalisation;
  • Covers 26 to 62 chronic conditions – with the base 26 conditions carrying no annual limit;
  • Offers highly flexible plans with the option of state, networked or open hospitals;
  • Health platform benefit for preventative care and screening;
  • Offers additional products like HealthSaver to help make medical saving easier;
  • Works in conjunction with the Momentum Multiply rewards programme.

Aside from price increases, 2020 changes for Momentum Health include the introduction of the Evolve option, and the falling away of the Impact option.

The major medical benefits on the Evolve option differ to the benefits that were available on the Impact option. For example, there is no longer an annual limit for maternity confinements and
neonatal intensive care.

The Evolve Option provides cover for hospitalisation at the Evolve Network of private hospitals. There is no overall annual limit for hospitalisation.

Associated specialists are covered in full. Non-Associated specialists are covered up to 100% of the Momentum Health Rate.

A co-payment of R1 570 will apply per hospital authorisation, except in the case of motor vehicle accidents, maternity confinements and emergency treatment.

You can view a detailed breakdown of changes to all Momentum Health plans here.

BestMed

  • Offers 15 plans Across 3 scheme categories.
  • Self-administered which means more of your money goes towards benefits and less towards administration;
  • No self-payment gaps;
  • Fewer co-payments – 75% fewer than competitors, the scheme claims;

For 2020, all limits and sub-limits have been increased by 5.2% across all options, and new benefits have been added to relevant plans.

For example, mammary surgery has been included as a benefit (up to R35,000) on Pace and Pulse 2 plans, while Diabetes Primary Care Consultations have been added to out-of-hospital benefits at 100% Scheme tariff.

For detailed changes to the schemes, you can view this document.

MediHelp

  • Offers 11 plans Across 5 scheme categories;
  • Full cover for 270 PMBs and 26 chronic conditions;
  • No annual limit on hospital cover;
  • Unlimited cover for trauma and emergencies;
  • On Prime options, you only pay for 2 children – the rest are covered for free;
  • Children can remain dependents until they are 26;
  • Access to online wellness programmes and emergency app.

On top of the sizeable increase of 11.9% on schemes for the year, MediHelp members will see an average limit increase of 5.4% in 2020. One of the biggest changes will be seen in the Necesse band of plans, which has been collapsed to two bands, which will result in some members seeing their fees increase by 30%. Other changes vary across the different plans, including more maternity consultations for members on Prime 2 and additional hospitals being added to the Prime network.

A breakdown of changes can be read here.

 

For information as to how Relocation Africa can help you with your Mobility, Immigration, Research, Remuneration, and Expat Tax needs, email info@relocationafrica.com, or call us on +27 21 763 4240.

Sources: [1], [2]. Image sources: [1], Natasha Spencer [2].

Andrew Stegmann

What to Look Out For in the South African Healthcare System

This article was provided to us by Chartered Employee Benefits, an independent employee benefits consultancy, based in Johannesburg, South Africa.

What to look out for in the South African Healthcare System

Whether you are an experienced traveller, expatriate or travel as part of your work, you will always be faced with the uncertainty of what is around the corner when moving to another country. Legislation, infrastructure and institutions may vary significantly from your home country. Healthcare is by no means the exception and you may find yourself seeking answers.

South Africa’s Healthcare Environment

South Africa has two prominent healthcare systems, the public and private healthcare sectors.
Albeit that the public healthcare system is free and accessible to all, it is not enough for those seeking consistent, quality, medical treatment which is aligned with global standards and is cutting edge.

There is, however, a stark difference between the private and public medical sectors in terms of cost. An estimated 9 million residents in South Africa (out of a total estimated population of 60 million) participate willingly in the private medical insurance schemes, at an additional cost/premium. The private medical insurance industry currently consists of just under 20 open medical schemes. These schemes attempt to mitigate the costs of what is regarded as a high quality, yet expensive private healthcare system. Discovery Health’s top 10 individual member claims in 2017 amounted to R48 million or $ 3 200 000 (Rand to US Dollar exchange rate estimated at R15: $1, at August 2019).

Closed medical schemes also exist in the private sector and are available to employees who work for specific companies or industries.

The intricacies of the South African medical scheme environment

South African medical schemes are structured around complex rules and stipulated requirements that they must adhere to, and function within the realm of the Medical Schemes Act, some of which are listed below:

Open enrolment – Open enrolment is a principle set down in law which requires open medical schemes registered in South Africa to accept as a member or dependant, any and every person who wishes to join that medical scheme.

Community rating – this rule prevents a medical insurer from varying premiums. All members on a particular plan must pay equal contributions, however the Medical Schemes Act does make provision for the inclusion of a ‘Late Joiner Penalty’ which may be applicable to members over the age of 35 years.

Prescribed minimum benefits (PMBs) – there are 270 medical conditions which are covered in full, however, medical schemes are able to manage these costs somewhat. This includes emergencies. Emergency medical treatment is defined as, treatment required as a result of an onset of a sudden and unexpected condition which requires immediate treatment. If not immediately treated, one of three consequences would result: serious impairment to a bodily function, serious dysfunction of a body part or organ, or death.

Waiting periods – South African medical schemes like all insurance products need to protect themselves from ‘anti-selection’ to avoid people from joining medical schemes when they need healthcare and exiting the scheme when they don’t require medical care. There are three types of underwriting conditions which might be applicable, singularly or in combination such as:

• The 3- month general waiting period with access to PMB’s
• The 3-month general waiting period without access to PMB’s
• The 12 months condition specific waiting period

These waiting periods can be waived by medical schemes on condition that your employer has an exclusive and compulsory medical employer group.

Premium and benefit increases – It is the general practice for medical schemes to allow members to increase their benefits during a window period, generally, September to mid-December, to take effect in January the following year. Premiums, benefits and medical scheme plans across all medical schemes might be altered during this period as well.

What if I travel outside of South Africa?

The general rule is that medical schemes will allow insurance for a certain number of days travel outside of South Africa. This is applicable to medium/high benefit plans. Pre-existing conditions are excluded and so too are specific countries (additional insurance may be required i.e. travel insurance).

If you spend longer than 90 days outside of South Africa, alternative insurance would need to be considered.

Is a South African medical scheme sufficient?
What about co-payments?

Like most medical insurances, South African medical schemes have copayments and short falls.

Example: If a medical practitioner charges 500% above the medical aid rate, you are liable for the short fall. This may be the case for several medical practitioners at once e.g. for childbirth, a gynecologist, anesthetist, pediatrician and a mid-wife may be present or required. All of which may charge above medical scheme rates. You will be responsible for the shortfall.

Copayments may be applicable to several procedures such as MRI, CT & PET scans as well.

Gap cover insurance is available and may insure the shortfall between the medical scheme rate and the applicable fees. The annual limit applicable to these products is R157 000 per person and your insurance may cover the whole family. You may not purchase gap cover insurance if you do not belong to a medical scheme. These premiums are ‘risk-rated’ and may vary depending on age.

How do I compare medical schemes?

An independent ‘non-tied’ (licenced to advise on a specific medical scheme) consultant may compare several medical schemes, objectively.

Healthcare consultants earn a maximum of R94.77 plus vat per month, or 3% plus VAT in respect of the contributions of that member, or whichever is lesser (this is already included in the premiums).

Participating in a medical scheme will reduce the potential risks associated with the public healthcare system.

If you are employed in South Africa, ask your employer if they have a medical scheme group in place and whether they have favourable underwriting. If you are eligible to join such a group, you may pay premiums and claim immediately. Seek advice from an independent employee benefits/ healthcare consultant. Open a South African bank account as soon as possible to ensure that you may get insurance coverage on arrival.

Many medical aid schemes in South Africa have information about the various plans they offer, what they cover, and their pricing, readily available on their websites, so it is a good idea to compare this way, before signing up. Major medical aid providers include Discovery Health, Bonitas, Fedhealth, Momentum, Genesis, and Medshield.

 

For information as to how Relocation Africa can help you with your Mobility, Immigration, Research, Remuneration, and Expat Tax needs, email marketing@relocationafrica.com, or call us on +27 21 763 4240.

Sources: [1], [2]. Image sources: Fas Khan [1], [2].