Funds hit hardby fake claims

While optimistic healthcare consumers were quick to predict a new trend that would see costs drop and benefits increase, early indications are that the lower than normal increases of the past few years were at best shortlived.

While optimistic healthcare consumers were quick to predict a new trend that would see costs drop and benefits increase, early indications are that the lower than normal increases of the past few years were at best shortlived.

Medical schemes are being hit hard by excessive claims from members.

Medicover believes the relatively low premium increases levied by most medical aid funds in the past few years are a thing of the past. In future the majority of members might pay dearly for the irresponsible actions of a few.

Claims are not necessarily fraudulent but rather consistent with a trend to get as much out of a scheme as possible - often without reason.

It is extremely difficult to close loopholes that allow irresponsible use of medical aid benefits. So schemes have no choice but to increase their premiums to remain solvent.

According to Dr Solly Motuba, appointed principal officer of Medicover from August 1 2008, the scheme has historically reflected conservative increases, while placing considerable emphasis on judicious management, impeccable service and innovative product design.

"It is this philosophy that has enabled us to substantially enhance services year after year," Motuba says.

"While affordability will always remain key, service delivery, product design, attractive, cutting edge benefits and corporate governance go hand in hand with running a good medical scheme.

Medicover has the advantage in this volatile climate of having maintained among the lowest premiums in the industry over a period of several years, while retaining some of the most generous benefits.

Medicover's philosophy is to keep it simple, offering medical benefits without add-ons, frills or surprises. This has not only kept annual increase below 10 percent for the past five years but also at the same time maintained and, in some cases, even improved benefits.

While the industry trend has been to keep increases low, many schemes have slashed benefits at the same time.

Come 2009 most medical scheme members will yet again have precious little in the offing when it comes to new benefits.

"Little wonder that we have in recent years seen an increase in healthcare consumerism, with many members publicly voicing their discontent," Motuba says.

Motuba brings extensive experience in the healthcare industry to the scheme and will be able to successfully and effectively steer Medicover into the future.

Over the past 18 months Medicover has gone through a number of changes to streamline and improve its service offering. With Motuba on board, members and brokers alike can look forward to a very bright future.

Medicover remains one of the most stable medical schemes in the country, with reserves well in excess of the required levels stipulated by the Council for Medical Schemes.

A key focus point at Medicover is that of corporate governance. Motuba says when board and committee members evaluated the governance of the scheme, the prognosis was really good.

"In our industry, and in the times we live in, good corporate governance is a non-negotiable," he asserts.

"We are committed to the protection of our members and are therefore cautious when it comes to unchecked growth," Motuba says.

"By the same token, we are all too aware that there is a certain 'safety in numbers' that holds an attraction of its own. Keeping the balance right is extremely important."

Due to a significant increase in the claims ratio in the past two years, Medicover has taken several steps to reduce risk and keep the scheme sustainable.

These include filters to reduce fraudulent claims, improving service delivery and enhancing communication with members.

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