Affordability a key factor in fund selection

CompCare believes its stable financial foundation must be matched with medical cover its members can count on, writes Lynette Dicey

Affordability is set to remain a key influencer for private health care consumers in the year ahead given the predicted low growth of just 2.2% for 2022, particularly when it comes to monthly contributions payable towards medical scheme membership, maintains Josua Joubert, CEO and principal officer of CompCare Medical Scheme.

“However, although affordability remains a primary concern in medical scheme selection, this alone is not a strong enough qualifier,” he says. “Affordability, together with a scheme’s financial stability, forms part of the foundation of worthwhile medical scheme membership, which then needs to be matched with cover members can count on if medical schemes are to play the role for which they are intended.”

CompCare recently announced a 5.75% average weighted contribution increase for 2022, just over 1% higher than the 4.6% implemented for 2021 and lower than the preCovid-19 6.5% average weighted increase implemented for 2020.

On some options, including the affordable NetworX option ideal for international students and employees under the R10,000 per month salary band the increase is as low as 3%.

Joubert says the scheme has been able to maintain a high solvency ratio of 47.2% which is well above the 25% required by the Council for Medical Schemes and considerably higher than some of the larger unrestricted schemes on the market.

“This translates to accumulated funds per member of more than R24,000 which ensures CompCare continues to be ranked as one of the most financially sound schemes in SA,” he says, adding that the scheme’s claims ratio of 92.6% is proof positive members are receiving significant benefit from the cover provided by their CompCare membership.

Throughout 2021 the scheme conducted member surveys and financial advisor feedback sessions. Benefit enhancements for 2022 have been based on this feedback.

“CompCare has 15 benefit options, including an efficiency discount option that offers exceptional value when using network hospitals and pharmacies. An inflationary benefit increase has been applied across all these options to ensure each member can benefit from enhancements, no matter which option they have selected, to best suit their health care needs and budget,” he says.

Benefit highlights for the year ahead include the fact that all Chronic Disease List (CDL) conditions will now be paid from risk rather than from the Annual Flexi Benefit. This enhancement, explains Joubert, is specifically being made to the Mumed, Selfsure, Symmetry and Dynamix options, including their Efficiency Discounted options, given that all other options in the CompCare stable already cover CDL conditions from risk.

From 2022 the scheme is removing the in-hospital pathology limit on the UniSave, Mumed and Symmetry options, including their Efficiency Discounted options, which will now afford members an unlimited benefit.

“Members are able to get exceptional value for money on our entry-level savings option, Selfnet, which also offers cover for eight antenatal visits with a GP, specialist or midwife payable from the risk benefit, which means it doesn’t cut into the member’s day-to-day savings,” says Joubert.

“In addition, a child emergency benefit is included which allows for a visit to an emergency room for children younger than six years old — for GPs and specialists to be paid from the above threshold benefit, while all procedural copayments have been removed.

Joubert believes CompCare ’ s outstanding child benefit and child rate — which is applied until the age of 27 for students and those who are financially dependent — will set the scheme apart for young families wishing to lay a solid health foundation for their children.

The scheme’s preventative men’s and women’s health benefits, as well as a wellness benefit, continue to be among the best on the market and is ideal for those seeking value while maintaining a healthy and active lifestyle, he adds.

“We are one of the only schemes in SA providing cover even if all available medical for injuries sustained during savings have been depleted.” professional and adventure

Enhancements on sports, as well as providing a CompCare’s Dynamix option for

2022 include in-room procedures for GPs and specialists to be paid from the above threshold benefit, with the limit having been increased by a full 10%.

The Pinnacle option, a particularly good choice for corporate executives, now also includes in-room procedures

search-and-rescue benefit,” he says.

Ever mindful of the growing need for mental health support, the scheme’s comprehensive psychosocial and emotional wellness benefit is included across all options with access to a round-the-clock counselling helpline and referrals for face-to-face counselling when required.

The scheme has also decided not to impose GP referrals or co-payments on dermatologist consultations charged within the scheme tariff for 2022.

“It remains to be seen just how far-reaching the ongoing impacts of the pandemic will be,” says Joubert.

“In the meantime, CompCare is forging ahead with benefit options that will address members’ real needs, providing them with access to the care they deserve in the here and now, protecting their health for the future and supporting them in achieving their wellness goals along the way. We have not forgotten every membership number represents a human being who relies on us to put their best health care interests first. We take this responsibility very seriously.”

WE ARE ONE OF THE ONLY SCHEMES IN SA PROVIDING COVER FOR INJURIES SUSTAINED DURING PROFESSIONAL AND ADVENTURE SPORTS