Boni­tas mem­bers’ con­tri­bu­tions to increase by nearly 12 per­cent next year

Weekend Argus (Saturday Edition) - - FRONT PAGE - LAURA DU PREEZ

Boni­tas Med­i­cal Fund, the coun­try’s sec­ond-largest un­re­stricted (open) med­i­cal scheme, has an­nounced an av­er­age con­tri­bu­tion increase of 11.9 per­cent for next year.

Last week, Dis­cov­ery Health Med­i­cal Scheme (DHMS), the coun­try’s largest scheme, an­nounced a weighted av­er­age increase of 10.2 per­cent, while Mo­men­tum Health mem­bers will face a weighted av­er­age increase of 11 per­cent.

DHMS’s increase would have been higher if the scheme had re­duced the con­tri­bu­tions to a med­i­cal sav­ings ac­count for dayto-day ben­e­fits on its Coastal Core Saver op­tion.

Boni­tas, which, ac­cord­ing to the lat­est Coun­cil for Med­i­cal Schemes data for the end of 2014, cov­ers about 650 000 mem­bers and de­pen­dants, has re­ceived the go-ahead from the Com­pe­ti­tion Com­mis­sion and the Coun­cil for Med­i­cal Schemes to merge with Lib­erty Med­i­cal Scheme, which had about 116 000 mem­bers at the end of 2014.

Dr Bobby Ra­ma­sia, the prin­ci­pal ex­ec­u­tive of­fi­cer of Boni­tas, echoed com­ments made ear­lier this year by DHMS and the Government Em­ploy­ees Med­i­cal Scheme that 2016 has been dif­fi­cult for schemes. He says med­i­cal in­fla­tion has ex­ceeded the Con­sumer Price In­dex by between three and five per­cent­age points.

Ra­ma­sia says the scheme has de­cided not to re­duce ben­e­fits to con­tain the con­tri­bu­tion in­creases, but to:

• Ne­go­ti­ate rates with “pre­ferred” health­care providers that mem­bers can use to ex­tend their ben­e­fits and limit their co-pay­ments;

• Increase the use of man­aged­care pro­grammes to de­tect and man­age dis­eases ef­fec­tively, co-or­di­nate care and en­hance well­ness among mem­bers;

• Part­ner with an in­ter­dis­ci­pli­nary team of doc­tors, phys­io­ther­a­pists and bioki­neti­cists that will treat mem­bers who have se­vere neck and back pain, to avoid the need for surgery; and

• Iden­tify mem­bers be­fore they de­velop high-risk con­di­tions.

The scheme also plans to change its Stan­dard and Stan­dard Se­lect op­tions to tra­di­tional op­tions with­out a med­i­cal sav­ings ac­count. A gen­eral prac­ti­tioner (GP) ben­e­fit will be payable from the risk ben­e­fit, and there will be a sub-limit for over­the-counter medicines.

Co-pay­ments for elec­tive hos­pi­tal pro­ce­dures have in­creased by about 24 per­cent on the BonSave, Pri­mary, BonFit and BonEssen­tial op­tions.

The scheme has in­tro­duced a new op­tion, BonCom­plete. It in­cludes a med­i­cal sav­ings ac­count, an above-thresh­old ben­e­fit (your claims are paid once the funds in your med­i­cal sav­ings ac­count have been de­pleted) and cover, paid from the risk ben­e­fit, for 31 chronic con­di­tions, and ba­sic and spe­cialised den­tistry. Hos­pi­tal cover is at 100 per­cent of the Boni­tas tar­iff, which means you could face a gap in cover if the doc­tors who treat you in hos­pi­tal charge more than this rate, as many do.

From next year, the scheme will not pay claims from your risk ben­e­fits for spe­cial­ist con­sul­ta­tions with­out a valid re­fer­ral from a GP.

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