JOHANNESBURG – Confirming what we’ve suspected all along, a recent medical aid survey emphasises that choosing the right medical aid is overwhelming and the endless nuance in medical aid plans makes meaningful comparison impossible.
In their efforts to make their plans more attractive, medical aids have introduced all kinds of additional benefits and options, only adding complexity and making comparison more difficult, according to Jill Larkan, head of GTC Healthcare Consulting.
Formerly Grant Thornton Capital, GTC exited the Grant Thornton stable in 2014. The 2015 Medical Aid Survey, which compares medical aid plans between 19 open medical schemes, is the fifth survey of its kind that GTC Healthcare has conducted for clients. This year its findings have been made public for the first time.
Even basic comparison a challenge
GTC divided medical aid plans into 11 different categories, drawing distinctions between starter plans, core plans, saver plans and comprehensive plans, as well as network plans and non-network plans within that.
Even with 11 categories the survey still excludes a number of points of comparison, such as out of hospital benefits and rewards programmes.
Although the majority of medical expenses members are likely to incur relate to in-hospital costs, if you are on expensive chronic medication and/or value the benefits derived from rewards programmes, then these considerations could be material in your choice of medical aid.
Traditional medical aid plans, where each benefit has a separate sub-limit (such as Bonitas BonClassic and TopMed Limited), are also excluded from the comparison.
“It would serve medical aid members, and the industry, if we were able to make direct comparisons between plans catering to different needs. At the moment, there is very little clarity on whether even a basic medical aid plan from provider X is better value than one from provider Y,” Larkan said.
She noted that, due to the way plans are currently presented, even straightforward questions around the level of cover needed in and out of hospital cannot be answered without expert advice.
When 100% is not 100%
While acknowledging that consumers look first at their bottom line, Larkan cautioned against comparing plans based only on premiums, pointing out that when it comes to medical aid, “you get what you pay for”.
“Understand what is covered in-hospital and out of hospital,” she stressed.
For example, when a medical aid says it covers ‘up to 100%’ (or 200% or 300%) of the scheme rate, this does not necessarily mean that it will cover your total hospital tab. While the medical aid will negotiate a scheme rate with the hospitals in its network, specialists in those hospitals may charge above that rate, which introduces a gap in cover.
Larkan advised consulting a professional, such as a healthcare broker or financial planner, for advice in choosing the right medical aid plan. “Broker commissions are included in your premium, so make sure you’re getting the requisite advice for the money that you’re paying,” she said.
It is worth noting that there is no single medical aid that is GTC’s preferred ‘cost versus benefit’ provider for 2015 across all the categories. Liberty, Discovery, CompCare, BestMed, Genesis, Profmed and Fedhealth are all included among the winners, with different plans from each emerging top in different categories.
Here is the list of preferred providers in various categories. To find out how each category is defined, visit page 13 of the survey.
Starter Comprehensive – No Network: Liberty Traditional Standard
Starter Comprehensive – Network: CompCare NetworX
Starter Comprehensive State Network: CompCare NetworX
Starter Core – Network: Discovery KeyCare Core
Core – Network: BestMed Beat 1N
Core – No Network: Genesis Private Choice
Saver – Network: CompCare MuMed NN R 501 – R 7 900
Saver – No Network: Bonitas Standard
Comprehensive – Network: Fedhealth Maxima Standard Net
Comprehensive – No Network: Fedhealth Maxima Basis