Delivering value and added benefits

• Scheme has introduced a number of member-centric innovations in the past year

Medshield Medical Scheme, which has announced a member weighted average contribution increase of 6.3% for 2022, has refined its product offering for the year ahead to address gaps raised by brokers.

Thoneshan Naidoo, Medshield Medical Scheme principal officer, reveals that the scheme has applied a 5.2% enhancement on specified benefits across all options with no benefit cuts, while at the same time allowing for additional GP consultations for chronic members. The scheme has also repackaged some of it benefits to allow for better value and added ease of access to care, including its Medshield Mom and Toddler benefits.

In deciding the annual contribution increases, explains Naidoo, the scheme needs to estimate what is going to happen in the next year, especially in light of the ongoing Covid-19 pandemic and the

demands made on the scheme in the event of a fourth or fifth wave of infections. “Many unknowns remain and we have a duty to ensure we can financially cover our members for the years ahead,” he says.

Medical schemes such as Medshield are not-for-profit organisations. The only way they can pay members’ health care claims is through member contributions. “We don’t have a profit motive, nor do we pay dividends to members,” explains Naidoo, adding that any surplus funds generated are always passed on to members as benefits.

Given that some medical scheme members are facing significant financial constraints in the wake of the pandemic, the decision facing all schemes is whether to consider lower contribution increases this year. However, a lower increase now could potentially result in above 15% increases in the future, explains Naidoo. “We decided to rather opt for a manageable increase this year and aim for a sustainable single digit increase next year. Ultimately, our aim is to ensure a consistent and steady increase both for next year and the year after that rather than a significant hike in the future. We are confident the increase we have decided on is sufficient to cater for any uncertainties, including sufficient reserves in the event of a fourth or fifth wave of Covid-19 infections or the need for a third vaccination.”

He reveals that the scheme has also had to take into consideration the impact of long Covid. Initial indications are that many people who have had Covid-19 are experiencing a number of long-term symptoms. “There are still so many unknowns around this virus we felt it was important to take a conservative view.”

In real terms, he explains, the monthly contribution increases on Medshield’s MediCurve plan — a revolutionary digital plan launched in the past year — resulted in a modest increase of R87 per member per month for 2022. “Technological efficiencies have enabled the scheme to offer this plan at an affordable rate of R1,485, ” says Naidoo, revealing this is the scheme ’ s lowest-priced plan.

The increase on its MediPlus Prime plan is R228 per member per month. Naidoo stresses, however, that the focus should not only be on the percentage increase but rather on the actual monthly contributions in rand value.

To improve the basket of options the scheme plans to introduce a new affordable hospital plan targeted at sports men and women which provides for sports-related injuries and rehabilitation for sports-related injuries, as well as a low-cost benefits option, both of which are subject to Council for Medical Schemes approval.

It ’ s a competitive market and to be sustainable schemes need to have a consistent focus on delivering value and improved benefits as well as attracting young and healthy members.

The scheme has introduced a number of member-centric innovations in the past year including building on its SmartCare Digital Healthcare Ecosystem to open the door for virtual consultations. The portal, explains Naidoo, is easily accessible via computer, smartphone or tablet.

“We’ve also enhanced the self-service functionality on the Medshield App and interactive website to allow for virtual GP consultations,” says Naidoo.

Not only will this make it easier for members to manage their day-to-day health care through these channels, but they can also benefit from the scheme’s health and wellness portal, Medshield Movement,

and the scheme ’ s loyalty programme at the same time.

Medshield ’ s 2022 product design strategy is aimed at addressing issues of affordability as well as access to quality, private health care, says Naidoo. “Ultimately, providing access to affordable, quality health care is at the heart of what the scheme offers.”

CONFIDENTLY COVERED Despite an expectation many medical scheme members would reconsider their medical cover given that SA has experienced one of the worst economic downturns in the country’s recent history, this fear has not been realised.

“In a health care pandemic you need medical aid cover more than ever — and you need to be confidently covered,” says Naidoo.

Since the onset of the pandemic Medshield has paid more than R500m in claims and vaccinated about 40,000 of its members.

WE DON’T HAVE A PROFIT MOTIVE. ANY SURPLUS FUNDS GENERATED ARE ALWAYS PASSED ON TO MEMBERS AS BENEFITS