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Health cover will cost up to 17% more

Personal Finance

The average contribution increase announced by open medical schemes for next year is currently averaging 10.34 percent, but some members will face increases as high as 17 percent.

In addition, members with gap-cover insurance for the difference between what their scheme pays and what a doctor charges for an in-hospital procedure may see their premiums increase by as much as 19 percent.

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This is according to an analysis by Alexander Forbes Health, which provides brokerage services to medical schemes.

Since the first schemes announced weighted average increases of 10 percent and 11 percent, many other open schemes have followed with increases of 11, 12 and even 13 percent (refer to this table).

Some restricted schemes, such as LA Health, have announced increases of between 8.4 and 8.9 percent.

Be aware that the average contribution increase may not reflect the increase for your option, and that the increases range from 2.3 to 16.9 percent.

In addition, Victor Crouser, the head of healthcare for the Western Cape at Alexander Forbes, says you need to know that, in an attempt to contain increases, schemes are:

• Reducing the portion of your contribution that is paid to a medical savings account (making the average increases misleading);

• Collapsing the salary bands on some options, with the result that members of some low-income options face increases of more than 25 percent;

• Changing the networks that you have to use;

• Increasing co-payments at rates that are well in excess of the inflation rate; and

• Increasing, at rates that are well above inflation, the thresholds at which you qualify for insured day-to-day benefits. You reach the threshold once your qualifying claims have exhausted the funds in your medical savings account and you have been through a self-payment gap.

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