Covid-19: counting the cost of claims

The pandemic had an impact on claiming patterns. Significantly, most schemes reported elective procedures were postponed.

CompCare Medical Scheme principal officer Josua Jourbert says the scheme has had about 3,500 positive Covid-19 cases among its membership base, and tragically lost 130 members to the virus. It has paid out just under R74m for Covid-related cases since the start of the pandemic in SA.

“We’re actively encouraging our members to get themselves fully vaccinated as soon as possible,” he says. “Currently 37.7% of our older members have received their jab but given we have a young member base, just 11.7% of all members have been vaccinated.”

Fedhealth reports it has paid R307m towards Covid-19 claims. This accounts for 10% of total annual claims and includes Covid-19 tests, admissions and vaccinations. By midSeptember the scheme had paid R60m towards close to 80,000 tests, Covid-19 admissions had cost it R230m, which includes R178m for ICU or high care admissions and R122m for cases that required a ventilator.

A Covid-19 admission is on average twice the cost of a nonCovid-19 hospital admission, reveals Fedhealth principal officer Jeremy Yatt. “To date the scheme has seen 26 admissions that were in excess of R1m each, the most expensive of which totalled R4m.”

By August 23, 70,220 Covid19 vaccinations had been administered to Fedhealth members which amounts to an estimated R30m.

“We estimate 29% of all Fedhealth members are fully vaccinated, with 50% having received at least one dose of the vaccination,” says Yatt.

Medshield Medical Scheme principal officer Thoneshan Naidoo reports that six of the 10 highest claims made by members in 2020 were Covid19-related claims. The largest claim, R7.6m, was by a member who experienced Covid-19-related complications.

An annual Covid-19 vaccination booster shot, should that be recommended, will cost Medshield an additional R100m per annum. “There are so many unknown risk variables that schemes have no choice but to be prudent if they hope to remain sustainable. We are expecting to see significantly more mental health claims. The stress and social isolation resulting from the pandemic has had an immensely negative effect on mental health worldwide leading to millions of people suffering in silence.

“Hopefully, through education, awareness and continued engagement, mental health issues will be destigmatised, making it easier for those in need to come forward, without fear, to get the assistance and support needed,” says Naidoo.

SCHEMES HAVE NO CHOICE BUT TO BE PRUDENT IF THEY HOPE TO REMAIN SUSTAINABLE