Bonitas Medical Fund, the country’s second-largest unrestricted (open) medical scheme, has announced an average contribution increase of 11.9 percent for next year.
Last week, Discovery Health Medical Scheme (DHMS), the country’s largest scheme, announced a weighted average increase of 10.2 percent, while Momentum Health members will face a weighted average increase of 11 percent.
DHMS’s increase would have been higher if the scheme had reduced the contributions to a medical savings account for day-to-day benefits on its Coastal Core Saver option.
Bonitas, which, according to the latest Council for Medical Schemes data for the end of 2014, covers about 650 000 members and dependants, has received the go-ahead from the Competition Commission and the Council for Medical Schemes to merge with Liberty Medical Scheme, which had about 116 000 members at the end of 2014.
Dr Bobby Ramasia, the principal executive officer of Bonitas, echoed comments made earlier this year by DHMS and the Government Employees Medical Scheme that 2016 has been difficult for schemes. He says medical inflation has exceeded the Consumer Price Index by between three and five percentage points.
Ramasia says the scheme has decided not to reduce benefits to contain the contribution increases, but to:
• Negotiate rates with “preferred” healthcare providers that members can use to extend their benefits and limit their co-payments;
• Increase the use of managed-care programmes to detect and manage diseases effectively, co-ordinate care and enhance wellness among members;
• Partner with an interdisciplinary team of doctors, physiotherapists and biokineticists that will treat members who have severe neck and back pain, to avoid the need for surgery; and
• Identify members before they develop high-risk conditions.
The scheme also plans to change its Standard and Standard Select options to traditional options without a medical savings account. A general practitioner (GP) benefit will be payable from the risk benefit, and there will be a sub-limit for over-the-counter medicines.
Co-payments for elective hospital procedures have increased by about 24 percent on the BonSave, Primary, BonFit and BonEssential options.
The scheme has introduced a new option, BonComplete. It includes a medical savings account, an above-threshold benefit (your claims are paid once the funds in your medical savings account have been depleted) and cover, paid from the risk benefit, for 31 chronic conditions, and basic and specialised dentistry. Hospital cover is at 100 percent of the Bonitas tariff, which means you could face a gap in cover if the doctors who treat you in hospital charge more than this rate, as many do.
From next year, the scheme will not pay claims from your risk benefits for specialist consultations without a valid referral from a GP.