THREE large open medical schemes have announced their contribution increases for next year, with average increases on two schemes coming in at just below 10 percent and the third coming in at more than 13 percent. Last year, medical schemes implemented increases that averaged about 6.2 percent, while claims that schemes paid on behalf of members rose by 12 percent. Schemes say the trend of contribution income not keeping pace with increases in claims has continued this year, making higher contribution increases necessary.
Discovery Health Medical Scheme announced an average increase of 9.8 percent for next year. Momentum Health said its increases would average 13.55 percent, and Bonitas Medical Fund announced an increase of 9.2 percent. Discovery Health's increases will range from 9.7 percent to 9.9 percent, and Momentum Health's increases will range from 11.68 percent to 16.23 percent. Bonitas will implement a 9.2 percent increase for all its members, regardless of the option to which they belong or the size of their families. Benefit options on all three schemes will remain the same, but benefits that are limited to rand amounts will be increased in line with the current projected inflation rate of about 6.8 percent. Discovery Health chief executive officer Neville Koopowitz said that contributions to - and hence available funds in - Discovery members' medical savings accounts would increase by an average of 9.8 percent. A new "trauma recovery benefit" will be added to all plans except the Core plans. This benefit will cover ongoing out-of-hospital treatment in certain cases following specific trauma events - for example, if a member or dependant was shot during a crime, or suffered severe burns, head injuries or paralysis after a stroke. The benefit will apply until the end of the year, when members can consider upgrading their cover if needed, Koopowitz said. Discovery plans to increase the amount it pays general practitioners (GPs) in its GP network for consultations from R195 to at least R215. The amount paid from a medical savings account for a consultation with a network GP would increase from R95 to R120. The scheme would continue to pay the balance. Koopowitz said that 73 percent of Discovery Health members' GP consultations were with GPs in its network. Discovery Health's reserves, at 21 percent at the end of June, are below the legal requirement of 25 percent of its contribution income, but Koopowitz said the scheme would reach the required level by the end of 2008.

Lee-Ann du Toit, Momentum Health's chief actuary, said that although Momentum's percentage increase would be higher than that of its competitors, the scheme's premiums on most options would remain very competitive and might be lower for the same or better benefits. She said that the biggest benefit change Momentum Health would introduce was a co-payment of either R500 or R1 000 on 22 specialised procedures, such as sinus surgery or gastroscopies, on the most popular options: Incentive and Extender. These co-payments were aimed at protecting members from high specialists' accounts, as the scheme would maintain its cover for specialists at 300 percent of standard tariffs. Momentum plans to establish a network of specialists that members can use without co-payments. Du Toit said that the Extender and Incentive options would also have a R5 000 limit per beneficiary per year on chronic medication that was not a prescribed minimum benefit. She said this limit would affect a very small percentage of members on these options. Primary healthcare benefits on the entry-level Base and Access options would be increased. Momentum Health's reserves are also lower than the 25 percent required by law. Du Toit said that this was a result of rapid growth in the scheme's membership. The scheme has obtained the Council for Medical Schemes's approval to merge with Meridian Health and, should Meridian members agree to the merger, Momentum Health could end the year with reserves of 22 percent. Gerhard van Emmenis, the chief operations officer of Bonitas, says Bonitas would increase the benefit for medicines taken home after hospitalisation. Some options would be enhanced by, for example, increased mental health benefits or benefits for hearing aids. Bonitas had reserves equal to 48.7 percent of its contribution income at the end of 2006.

Laura du Preez: Personal Finance, 22 September 2007