Confused about medical cover? Here’s help

The annual GTC survey provides a standardised comparison and ranking of the medical scheme options available to you. reports

CHOOSING a medical scheme from those available to you and then choosing a plan, or option, offered by the scheme that fits in with both what you can afford and the level of health care you need is likely to leave you confused. Not only are many offerings by the medical schemes highly complex, but myriad differences make them difficult to compare.

The annual GTC Medical Aid Survey does much of the hard work for you by analysing and rating medical schemes and providing a standardised comparison and ranking of the choices available to you – and the results of the 2017 survey have just been published.

GTC, formerly Grant Thornton Capital, is a leading financial advisory business, established in 1991 from within the Grant Thornton Johannesburg audit practice, itself part of Grant Thornton International.

The medical scheme survey has been produced annually since 2011.

Jill Larkan, the head of healthcare consulting at GTC, who is responsible for the survey, says it “cuts through the notoriously complicated landscape of the medical aid industry and simplifies it according to the factors that matter most when consumers choose a medical scheme and option”.

Commenting on the 2017 survey, Larkan says although smaller medical schemes are offering good value for money, they have not been as successful as some of the larger schemes in attracting new members, which is essential for the financial health of the scheme over the long term.

This year’s survey reviewed 23 open medical schemes and one closed (limited-membership) scheme, with a total of 144 options, which fell into 11 categories according to the benefits offered. The categories ranged from entry-level and hospital options to saver and comprehensive options. Healthcare policies offered by insurance companies were excluded.

When you compare medical scheme offerings, you’re likely to concentrate on value for money: what you get in return for your monthly contribution. But you also need to consider how financially Non-network healthy the scheme is, and how sustainable it is into the future.

Both the value-for-money and the financial health aspects are taken into account in the survey, which gives each option a micro rating (indicating an option’s value-formoney competitiveness in relation to others in the same category) and a macro rating (which considers factors such as membership size and growth, average age and financial stability).

“Fedhealth is one of the schemes that has performed consistently well in the micro ratings, indicating that it is very competitively priced and can offer consumers good value for money,” Larkan says.

Discovery Health, the country’s largest open scheme, came tops in the macro ratings.

The options were further divided into network and non-network options (those that confine members to a network of providers versus those that let members freely choose their providers) and were rated according to three types of membership: single, couple (two adults) and family (two adults and two children).

The full survey, which is available at www. gtc. co. za, provides detailed scoring and cost analysis, which is then simplified by GTC’s “likelihood of support” rating of high, medium, or low, Larkan says. “This indicates the likelihood of us recommending a particular plan, given the scores.”

The macro and micro rankings combine to create GTC’s overall list of schemes ranked by “likelihood of support” (see table).

Larkan says: “The list reflects the overall best-scoring plans in our comparisons across all sectors. This is by no means a definitive or final rating, as ‘soft’ factors, such as existing servicing relationships, past experience, administration ability, and customer service, have not been taken into account.”

martin.hesse@inl.co.za