Members over estimate cover or overspend on plans
MEDICAL Aid Members commonly believe they have cover which they don’t, while often spending far more on a plan than necessary, according to the 2018 GTC Medical Aid survey of benefit and cost comparisons. A recurring theme in the research was a failure to establish the optimum combination of medical aid and appropriate gap cover. As were misdirected premiums and poorly thought-through benefit selection. Moreover, salary increases have, on average, not kept pace with medical inflation which highlights the complexity of an industry facing two major Bills and seismic changes. As Gary Mockler GTC Group Chief Executive Officer comments, “The pending NHI (National Health Insurance) and amendments to the Medical Schemes Bill are inevitable. The disparity between the have’s (some eight million members) and the have-not’s (some 45 million) is real and needs addressing. Government intervention is urgently required. It is however equally important to not break that which is already working. As with some many other pressing South African socio-political issues, cool heads, calm nerves and commercial logic need to prevail.” While Minister of Health Aaron Motsoaledi has mooted the scrapping of Medical Aid brokers, Medihelp’s Principal Officer Heyn van Rooyen, among others, has been quick to emphasise the importance of accredited advisers. Brokers, he adds, are subject to stringent compliance rules, such as accreditation with the Council for Medical Schemes, and industry-related examinations. They also undergo considerable training. Mockler says GTC research confirmed the benefit of wellness programmes to members, employers and schemes alike, far outweighing their cost. “The continued deterioration of our country’s ‘Burden of Disease’ must be of increasing concern to Risk Management Committees of all employers. Businesses and organisations now have the opportunity to engage with the wellness programme suppliers in an effort to curb future increases and monitor deteriorating staff health issues. Now in its sixth year, Consulta’s South African Customer Satisfaction Index (Sacsi) is an independent national benchmark of customer satisfaction of the quality of products and services available to household consumers in South Africa. The 2018 survey reveals that, on average, customer satisfaction fell from 74.2 last year to 72.7 this year. Only two schemes performed above average. Medihelp’s satisfaction level was 75.1, up from 72.6 last year (a 2.5 improvement), while Discovery’s satisfaction level was 73.1 (down by 1.7 from its 74.8 score last year). Medihelp also performed well in Sacsi’s Perceived Value Index , with a rating of 73.6 compared to the industry average of 69.4. It showed strong improvement in terms of the Treating Customers Fairly measure, with a rating of 78.3. Consulta CEO Prof Adré Schreuder reports, “There has been a general decline in the customer satisfaction of members of medical schemes on an industry level in the past 12 months. This was primarily the result of members of Discovery and Bonitas, two of the biggest players in the industry, rating their schemes slightly lower on aspects relating to satisfaction and value for money. Only two schemes managed to improve their position on ratings of customer satisfaction from last year, namely Medihelp and GEMS.” Satisfaction levels for medical schemes are substantially lower than those measured in other financial services industries and the claims process is where most frustration is felt. “Members,” he elaborates, “often feel that they do not receive the cover and benefits they expect from their medical scheme and this is most strongly expressed when claims are not honoured or paid in full.” The multitude of medical insurance products is confusing so, while the market’s dominant heavyweights remain strong, Schreuder suggests that pack leader Discovery has shifted focus to other business offerings thus allowing its competitors “to even out the playing field in the medical product suite by delivering simpler, traditional medical insurance that is seen to be less expensive and easier to understand,” He cites Medihelp as a good example – three years ago the scheme was in a below par position. Efforts to focus on delivering a simplified product, coupled with improved service levels, has resulted in strong improvements in the perception of value for money and overall customer satisfaction. The 2018 sample included 1675 respondents randomly selected from five medical schemes.