Medical Aid considerations in the time of a pandemic

The start of a new year brings with it a likely increase in your monthly medical aid contribution. Now is the time to decide whether to upgrade or downgrade your cover in 2021.

Nicky Sass

Healthcare Consultant

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Medical Aid considerations in the time of a pandemic

Premium increases to expect

In previous years, the Council for Medical Aid Schemes (CMS) has recommended medical aid providers increase their premiums by inflation + 3%. This was widely seen as an affordable increase for most members.

However, the pandemic is likely to have changed things for a majority of us. You might now be faced with a reduced salary or no income at all. As a result, CMS has encouraged medical schemes to freeze their contribution increases or to limit increases to 3.9% for 2021.

The final decision as to how much to increase premiums by lies with the medical aid provider and they have to determine what level is feasible for them. For some schemes, such concessions may be unaffordable due to unique, industry-specific cost factors (like a weaker rand) over which they have no control. Ultimately, increasing the contributions by too little could put these sorts of businesses, and by extension the end-clients, at risk in the long term.

The below table details the type of increases some of the main providers are going to implement in 2021.

Table 1: Weighted average contribution increases of the respective medical aid plans for 2021

Medical aid provider	Percentage premium increase for 2021
Discovery Health	Contribution freeze up until 30 June 2021 – thereafter an increase of no more than 5.9%
Momentum	3.9%
Bonitas	4.6%
Medshield	5.9%
MediHelp	5.8%

Options to consider

At this time it might be unclear as to whether you should upgrade your cover (to provision for further health scares like we had in 2020) or downgrade your option because of financial pressures.

Your first instinct may be to terminate cover altogether. We advise against this, unless it’s the absolute last resort.

Some other ways to consider:

You could reduce your cover to in-hospital benefits only. But then you’ll need to fund all out-of-hospital expenses (think medication purchased over the counter) from your own pocket.
Making amendments to gap cover could also be another way to preserve or increase your out-of-hospital cover.
If you need to increase your cover, you could look to some of your other household expenditure to see where you can cut back in order to afford an increase in your medical aid premiums.

How do providers stack up against each other?

Virtual capabilities:

To encourage behaviour that will limit the spread of the virus, medical aid schemes have looked at how they can provide their members with the necessary services while limiting the need for human interaction. Each scheme has developed a virtual platform that allows members to engage with them from the convenience of their own homes, at times suitable to them. These virtual offerings are listed below:

Discovery Health has an existing app and they’ve introduced Connected Care.
Momentum Health has an existing app and Hello Dr
Bonitas has an existing app which provides virtual care
Medshield has the SmartCare benefit and app
MediHelp has virtual functionality available on its member zone

Each of these platforms gives their members access to virtual consultations, subject to scheme terms and conditions.

Wellness programmes:

Each medical aid scheme has a unique wellness benefit available to their members, encouraging them to become active and live a healthy lifestyle. We summarise their nuances below.

Discovery Health’s Vitality programme focuses on behavioural change, rewarding members who exercise regularly, eat well, and perform the relevant annual health checks.

Momentum Health’s Multiply programme allows members to earn health returns based on their physical activity, healthy heart score, and member status. Health returns can either be swept into the member’s Health Saver account or bank account if no Health Saver is active.

Bonitas Health has partnered with Sanlam Reality which empowers members to improve their lifestyle and wellbeing by getting active. They also provide their members with an Extender Benefit once they’ve completed their health screening, which in turn unlocks the extender to pay for specific benefits subject to the member plan type.

Medshield has launched online workout programmes called Medshield Movement and ClickFit, with the initiative aiming to empower members to live their best lives through improved fitness, nutrition, and healthy behaviours.

Whether you’re an individual, or a business, we can help you maximise your healthcare scheme according to your needs and budget, saving you precious time and effort by taking care of the details for you. Partner with us for your healthcare needs.

MediHelp provides an online wellness programme called Health Print, which initiates and promotes health support for its members.

Lessons from the pandemic

COVID-19 has highlighted the need to always have the correct medical aid cover in place, tailored to the needs of the individual in question; cutting corners can be disastrous when unplanned or unexpected events occur.

Deciding on the optimal amount of cover can be difficult as there are many pros and cons to consider. A financial advisor is able to put your individual circumstances into context, and help you put together a medical aid solution that protects your health while taking into account your other financial commitments.