Medshield ups benefits, while keeping 2023 premium increases to a minimum

Medshield Medical Scheme announced its benefit options and contributions for 2023 on Thursday. In doing so, it affirmed its commitment to being a healthcare “Partner for Life”, with an appropriate product for every life stage of its members, from early adulthood to retirement.

The scheme has made significant enhancements across its plans — from affordable entry-level options to fully comprehensive medical aid cover — to ensure the best possible offering to its members, while keeping its annual premium increases as low as possible.

Medshield will support its members with an average 5.5% increase on specified benefits across all options in 2023, and reduced and removed co-payments on specific procedures. The scheme also unlocked unlimited GP consultations for selected conditions once members’ Day-to-Day or Savings allocation has been depleted.

Impressively, considering healthcare inflation and the current state of the economy, the scheme is able to provide these and other enhanced benefits to members at a minimum weighted average contribution increase of only 6.7%.

A member-centric approach

“I am proud to confirm the scheme's utmost dedication to ensuring all members and their dependents continue to receive much-needed quality health care,” said Alan Fritz, Medshield's acting principal officer.

Fritz said the Covid-19 pandemic’s lasting changes to our personal lives, our careers, the economy and certainly on the SA healthcare industry cannot be ignored.

“Before we even started with the design process of our 2023 product offering, we approached our members and brokers to ascertain their needs, and refined our product offering to address the gaps raised. We have thus enhanced and improved the Medshield basket of options accordingly, subject to the Council for Medical Schemes’ approval.

“In the wake of the Covid-19 pandemic, the increased interest rate, electricity costs, and the fuel price hike wreaked havoc on the disposable income of South Africans, and we kept this in mind during the design of our 2023 offering. We placed the interest of our members first and kept our 2023 annual [premium] increase as low as possible.

“If one takes into consideration the predictive costs of the benefit and other enhancements, such as reduced co-payments to assist members with affordability, and balance that with the long-term sustainability of the scheme, the increase in premiums would have been unaffordable for our members.”

Medshield is able to offer its members enhanced benefits, while keeping annual premium increases to a minimum, by funding a portion of the cost of such benefits from its reserves.

“One major differentiator and competitive advantage is that, unlike many of our competitors, Medshield is self-administered and is a not-for-profit organisation: we don't have a profit motive, and we don't pay dividends to shareholders. So that means our members benefit from any surplus [savings] we generate,” said Fritz.

Effectively, in real terms, the annual contribution increase means members on Medshield's MediCurve plan, for instance, will experience an affordable R99 increase in their monthly premiums.

Though Medshield is the first of the SA medical schemes to announce its annual product offering, it expects this to be below the industry average, providing excellent value, especially with the increases in benefits and the decrease and removal of selected co-payments.

“We hope these measures will add value to the lives of our members and support them in these trying times,” said Fritz.

The freedom to innovate

“Medshield is in a good position,” said Fritz. Due to prudent strategic decisions and financial management, the scheme is financially sound with above-average reserves, which ensure that it can pay claims — whether another pandemic hits unexpectedly or not. 

Being financially sound also affords Medshield the freedom to innovate and provide more benefits and choices to members, such as the launch of the new hospital plan, MediSwift, earlier this year. 

In addition, it ensures that the scheme is able to embrace technology to keep up with the need to deliver health care in an innovative, safe and cost-effective way.

This is achieved through the ever-evolving Medshield SmartCare stable of offerings, which enables quicker access to quality health care with telemedicine via Videomed and virtual GP consultations accessible through any computer, smartphone or tablet from the comfort of a member's home or private space. 

The hospital-at-home benefit allows members to receive hospital-level treatment at home through 24/7 digital monitoring and personal care where required, and the WhatsApp Doc advice line, introduced at the beginning of the pandemic, allows members to get advice from a registered GP. Medshield found that, though the instances of Covid-19 have dropped, many members are still using this line to get informed advice on this and other conditions.

Medshield's 2023 benefits will continue to focus on co-ordinated managed care to deliver:

• Easy access to a range of healthcare services and providers;
• Good communications and effective care plan transitions between providers;
• A focus on the total healthcare needs of the patient; and 
• Clear and straightforward information that members can understand.

“Our enhanced service focus strategy embraces the digital age by introducing higher levels of member self-service through the Medshield App, faster resolution and informed and knowledgeable assistance by our contact centre,” said Fritz.

Your ‘Partner for Life’

Fritz sees three clear evolving trends in the SA healthcare industry.

First, schemes with large risk pools have benefited from a reduced level of elective procedures during the pandemic. However, medium and smaller schemes that had high levels of hospitalisation for Covid-19-related illnesses could face even further claims related to Long Covid-19, with an increased burden of chronicity, which may lead to financial viability challenges.

Second, medical schemes and thus their members are affected by prescribed minimum benefits regulations which allow specialists to determine the cost associated with a procedure. In Fritz's view, this is not sustainable for medical schemes or their members as it leads to higher contribution increases. Coupled with the shrinking economy and resulting job losses, many people may not be able to afford medical aid, leading to a shrinking medical aid market.

Lastly, Fritz predicts that this will result in medical schemes' consolidation. There are presently 17 open schemes, but this number could be reduced by the end of 2022. In future, he believes there will probably be five to 10 schemes coexisting with the National Health insurance (NHI).

Being financially sound affords Medshield the freedom to engage in strategic discussions to ensure the scheme is one of the remaining private healthcare schemes once the NHI is implemented.  

“Members with long-term partners will know that support, care, connection, reliance, trust, loyalty and happiness are all qualities you seek when choosing a partner for life. Medshield has many members who have partnered with us for 15 years and longer, knowing we have their best interests at heart,” said Fritz.

“We are a stable organisation that will be around in the long-term, with a menu of member-centric benefit plans to cover our members’ needs as they navigate through life's journey. Medshield is your healthcare 'Partner for Life'.”

This article was paid for by Medshield Medical Scheme.