Two big medical schemes to up rates by 8.9%

By Laura du Preez Time of article published Sep 15, 2013

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The country’s largest open medical scheme and the seventh biggest scheme this week announced average contribution increases of 8.9 percent for next year.

Discovery Health Medical Scheme, with 2.4 million beneficiaries, will increase the contributions on all its options by 8.9 percent, while the increases on Fedhealth, with 152 070 beneficiaries, range from 7.9 percent to 10.9 percent.

Another smaller scheme, KeyHealth, has also announced an 8.9-percent contribution increase.

Discovery Health’s chief executive officer, Dr Jonathan Broomberg, says Discovery Health Medical Scheme has the lowest cost inflation in the industry and its contributions are, “on a benefit-adjusted basis”, on average 15 percent lower than all other open medical schemes in South Africa.

According to the Discovery Health’s The Discoverer newsletter, Discovery Health Medical Scheme beneficiaries (members and dependants) pay R11.43 a month more for administration than the average for all other medical schemes. However, as a result of this additional expense, scheme beneficiaries pay R158.24 a month less in contributions.

The Discoverer states that the scheme will decrease its chronic illness medicine limits to “reflect price reductions on a number of medicines”.

It says this is a result of ongoing negotiations between Discovery Heath and various pharmaceutical groups during the year and the new limits will be implemented from July next year.

Alexander Forbes Healthcare says co-payments, deductibles and benefit limits that apply to Discovery Health Medical Scheme’s options will increase by 8.9 percent, except the co-payments for MRI/CT scans and benefit limits for oncology, specialised medicines and prostheses for hip and knee joints, which will remain constant.

The limits for surgical devices, The Discoverer says, will increase by surgical inflation of six percent.

Alexander Forbes says the threshold levels on Discovery Health Medical Scheme’s Executive, Comprehensive and Priority options have increased by between 8.24 percent and 10.26 percent.

The scheme has appointed MedXpress as a designated service provider that members of the Delta options will have to use for chronic medicines or face a 20-percent co-payment on their chronic medicines.

The Discoverer says the terminal care benefit has been enhanced by 30 percent and will include pain relief, hydration, nursing and support care.

Benefits for members expecting a baby have been enhanced: they will be able to access paid-for antenatal consultations and scans through a network of providers once their medical savings accounts have been depleted.

The scheme has appointed a preferred supplier for expensive appliances, such as wheelchairs. Members who do not use this supplier will be reimbursed at only the Discovery Health rate for these appliances.

Discovery has also drawn up a preferred list for medicines for acute conditions (as opposed to those for chronic ones). These “preferentially priced” medicines include generics and brand-name ones. Members on the Classic, Comprehensive, Classic Delta Comprehensive and Executive options will be able to access these medicines as insured benefits when their savings accounts are depleted.

If these members’ medical savings accounts run out during the year, they will be able to get these medicines as well as blood tests from certain pathologists paid for by the scheme.

In addition, if you are on an option with above-threshold benefits, the medicines on the preferred medicine list will count in full towards the threshold.

Discovery Health is offering a new wellness offering to companies that sign up their employees. The programme includes a range of preventive care strategies, health information, data and analysis and corporate wellness intervention strategies.

Alexander Forbes says Fedhealth has launched two new options in its Maxima range aimed at younger members: Maxima Saver and Maxima Entrysaver. Both options offer private hospital cover, with the Maxima Saver option giving freedom of choice and the EntrySaver restricted to a network of hospitals.

The scheme has also discontinued its most comprehensive Ultima 300 option. Members in this option will default to the comprehensive option in its Maxima range unless they choose a different option.

Alexander Forbes reports that most of Fedhealth’s benefit limits and co-payments have increased by six percent.

Peter Jordan, the principal officer of Fedhealth, says the scheme has a network of 4 400 GPs and 3 400 specialists, and a high proportion of claims for consultations are for the services of these doctors.

Jordan says the objective of the networks is to ensure that members have meaningful benefits without having to resort to out-of-pocket payments.

Jordan says that at the end of July Fedhealth’s reserves stood at 38 percent – above the 25 percent required by law.

Discovery Health Medical Scheme had a reserves of 23.4 percent at the end of 2012.

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