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How lack of understanding increases complaints and impacts rankings (part 2)

GTC Medical Aid Survey 2018 (part 2) – How lack of understanding increases complaints and impacts rankings

At a media roundtable releasing the GTC 2018 Medical Aid Survey (MAS) Jill Larkan, Head: Healthcare Consulting, of leading wealth and financial advisory firm GTC, welcomed the greater medical aid diversity. The GTC survey analyses and rates medical aid schemes according to a standardised comparison and ranks the choices available to members.

In part 1 we focussed on the survey’s analysis in terms of premiums, a comparison of average annual salary increases against average annual medical aid premium increases as well as the method of the survey’s micro and macro rankings.

The Survey also made mention of the Council for Medical Schemes’ (CMS) report to Parliament earlier this year where it was shared that complaints from medical aid members have increased by 29% from 1 017 to 4 536 during 2017-18, compared to the previous year. This was largely attributed to a lack of understanding of the cover provided by their medical aids.

“This is in line with our experience: one of the biggest reasons for members’ unhappiness about a selected scheme is not knowing what their plan pays for. As there is no standardisation in the medical aid industry, it is very complicated for members to analyse medical aids, without the help of experienced professionals,” Larkan says.

This year’s survey reviewed 21 open schemes and one closed scheme (Profmed) covering 22 plans divided into five categories, eight subcategories and three micro categories. Many of these were further split between network and non-network schemes; whilst some of them go on to reflect day-to-day spending levels. The full range of plans has been graded according to GTC’s ‘likelihood of support’ and offers a simplified method of comparing options and cost for members.

Larkan explains that, in addition to factoring in complaints received from members on social media sites such as Hellopeter.com – as an indication of members’ satisfaction with their medical aids – this year’s macro grading also took into account the compliments that schemes received, as well as the Hello Peter Index.

Bonitas moved up seven places in the macro rankings as a result of Liberty’s members being amalgamated into the Bonitas scheme. “This greatly enhanced the number of members on the scheme, which carries the highest weighting in the GTC macro rankings. The long-term effect of this amalgamation on measures such as net healthcare results will remain to be seen in the next year, when the claiming patterns of the new members are experienced in the Bonitas scheme.”

Larkan is also encouraged by the number of schemes that are giving due consideration to maternity benefits. “There are generally good benefits for young families, which means they can cover many items – including antenatal classes, maternity scans and consultations – out of the general risk carried by the scheme, without having to dip into their savings accounts.”

The table below shows the ranking of GTC’s micro and macro gradings combined, for a family (principal member, spouse and two children):

Macro combined Best performer
Entry Level Comprehensive
Low Income
Momentum Ingwe Network
R676 – R6 300
Entry Level Comprehensive
Medium Income
Discovery KeyCare Plus
R0 – R8 550
Entry Level Comprehensive
High Income
Bonitas BonCap
R7 500 – R12 194
Entry Level State
Low Income
Momentum Ingwe State
R0 – R675
Entry Level State
Medium Income
Momentum Ingwe State
R676 – R6 300
Entry Level State
High Income
Discovery KeyCare Access
R8 551 – R12 200
Hospital Plans – Network Bestmed Beat 1 Network
Hospital Plans – Non Network Bestmed Beat 1
Saver Only Plans – Network Bestmed Beat 2 Network
Saver Only Plans – Non Network Bestmed Beat 2
Saver Plus Plans – Network Compcare Symmetry ED
Saver Plus Plans – Non Network Medimed Medisave Standard
R0 – R8 500
Comprehensive Plans Risk Only – Network Discovery Essential Delta Comprehensive
Comprehensive Plans Risk Only – Non Network Discovery Essential Comprehensive
Comprehensive Plans Complete Costs – Network Discovery Essential Delta Comprehensive
Comprehensive Plans Complete Costs – Non Network Discovery Essential Comprehensive

Larkan concludes: “Given the complexity of the medical aid industry and the varying needs of members, it is more important than ever for members, with the help of their healthcare advisor, to do a thorough analysis of their needs and means; and compare this to the options available in the healthcare market, before deciding on a scheme and then a plan option for their future.”

Click here to download GTC’s full survey.

News Release issued by StratComms Advisory Services on behalf of GTC Holdings.

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