Medical aid choice fraught with complexity

‘Comparison near impossible’ – healthcare consultancy.
Jillian Larkan, head of GTC Healthcare Consulting.

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.

The winners

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


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Medical Aid Societies are an absolute rip off – they have moved far,far away from being client focused to being money spinning operations for the scheme – look no further than Discovery for a typical example of how medical aid companies can make their directors disgustingly wealthy

My experience with medical aids, unplanned emergencies that get you booked into hospital immediately generally get covered, with anything else you get killed. The worst is if you need some kind of non-emergency op (e.g. a knee op). Anesthetists fees covered by our medical aid comes to about 40% (this after 3 ops in the past year for the family), specialist fees are also only about 25-50% covered. The rest is out of your pocket….. the biggest farce is the 100% or 150% of the “rate”. What the heck is the “rate” how is it determined or standardized? All very, very opaque.

I’m on Discovery coastal core. It’s really basic, with no savings plan option. They’re not interested in providing it.. I also have medical insurance gap cover, since 100% ‘cover’ according to Discovery can be divided by four, at least. The term medical-aid is a misnomer, but with Discovery, their Vitality propaganda/PR dept offers you ‘cheap’ this and that, but note, no reduction in your fees or increase in benefits if you exercise a thousand times a month at Virgin, or eat so called healthy foods from PNP, etc. I don’t think that they’re really interested in the ‘medical-aid’ business; just data-mining and linking that to their insurance business, perhaps?

End of comments.





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