The medical scheme annual review season is a challenging time for companies and members having to navigate through the hundreds of available options. Jargon and the plethora of structures exacerbate the process. The 2021 season is more complex due to the COVID-19 impact on medical schemes causing surpluses and resultant contribution increases at different times of the year. In this blog, we share five helpful tips.
1. Medical Scheme Evaluation
We recommend that you evaluate medical schemes in terms of financial performance. Key statistics like solvency, reserves and historical annual increases are essential indicators. Other key aspects to consider are administration efficiencies like claims administration and benefit to cost ratios.
2. Major Medical Benefits
The overwhelming majority of members want to ensure they are fully covered for the high uncontrollable expenses.
An important consideration is your choice of hospital. You could either select an option that provides the freedom of choice to go to any hospital or consider a network option providing cover for a network of private hospitals for planned and elective procedures. On network options, you can go to any hospital for emergencies. In addition, network options offer members reduced monthly contributions hence attractive to some members, especially if the specialist practice at the network hospital or the hospital is near their place of work of residence.
The logical next step is to consider the reimbursement rate, in other words, 100%, 200% or 300% of the medical scheme rate. We strongly recommend that you consider adding gap cover to increase the reimbursement rate by up to 600%. Comprehensive gap cover options provide a broader range of additional benefits like co-pays, deductibles, sub-limits, cancer gap, etc.
3. Chronic Medication
All medical schemes must provide for the 28 prescribed minimum benefit chronic conditions. However, comprehensive options cover up to 60 chronic conditions. Therefore, if your chronic condition is not on the prescribed minimum benefit list or not listed on the medicine formulary, you may need to consider a more comprehensive option.
4. Claims History & Planned Procedures
It is crucial to review your past claims utilisation and planned procedures to determine your day-to-day or out-of-hospital needs. This process will help you understand how much you will require for GP visits, prescribed medication, specialist visits, optometry, dentistry, auxiliary services, etc. Some clients prefer medical scheme hospital plans and self-insure day-to-day benefits. Others have no option but to purchase a comprehensive benefit structure due to their day-to-day needs. Others will insure their day-to-day needs via a primary healthcare plan.
5. Loyalty & Rewards
Loyalty, rewards and product integration is important considerations. Often cash backs and integration discounts are material and can save your money.
Selecting a medical scheme or option is a complex process. Therefore, we recommend that you solicit the help of an accredited healthcare broker that is licensed for long- and short-term insurance like Phoenix Healthcare Consultants. We conduct a comprehensive needs analysis and provide clients with a detailed report and record of advice.
We are proud of our ability to bundle and integrate products, enhancing your benefits and reducing costs.
Complete your details on the contact section on your right for a no-obligation free consultation.
Author: Clayton Samsodien
Group CEO
DISCLAIMER
This blog does not constitute financial advice. The content is intended to provide information for educational purposes. We recommend that interested parties contact Phoenix at the contact details listed or their financial advisors for a comprehensive review and needs analysis followed by the required record of advice.