MEMBERS SHOULD NOT BE EXPECTED TO SHARE INDUSTRY’S STRAIN
The funded healthcare sector has been under strain for more than a decade but the real challenge is to alleviate the misconception that medical scheme members have to carry the burden.
So says Selfmed’sMarthie Besterwho adds, “There’s no denying that we operate in one of the country’s toughest and most regulated environments, not least the new dispensing fee structure. And, of course, the global economic crunch didn’t help but, while many schemes have either fallen by the wayside or leaned heavily on their members, others have been tempered in the fire.
“We, for example have been in the business for 45 years, with no major changes to our options other than to increase the limits within them. We don’t even insist on preferred providers because we understand the emotional bond members have with their healthcare providers and the hospitals they have confidence in.”
She advises South Africans not wanting to be caught in the spiral of increasing contributions and decreasing benefits to choose a scheme that has a history of stability, healthy reserves, service excellence and offering value for money.
The last, she adds, should not be confused with cheap, “Real value emanates from having the right cover to fit one’s needs.”
Elaborating on stability, Bester says this is as much about the stability of the scheme’s management and long serving trustees as about well above average reserves to cushion the scheme through difficult situations.
“Combine these factors with constant, sustained and controlled growth, good options and an excellent reputation for prompt payouts and you can rest assured that members will be satisfied.”
Founded in 1965, Selfmed is a self administeredopen medical aid scheme and is one of a few to have joined the Ethics Institute of South Africa.
Bester adds, “As importantly, because medical aid is not just about number crunching, our service excellence centre provides 100 percent support to employers as well as members of the scheme.”
With reserves standing at 45%, Selfmed’s solvency levels are well in excess of legislative requirements. She attributes the scheme’s extremely favourable financial to the diligence and active participation of its Board of Trustees.
By law all schemes need to have a 25 percent solvency level. Should a scheme not manage to maintain its reserves at this level, the Registrar may put the fund under review, invoke changes to benefits and contributions and, in extreme cases, even put the fund under curatorship.
Bester says schemes that are in trouble tend to cut benefits and raise contributions. “This is when you find the younger members bailing out and the older more vulnerable ones bearing the brunt of a difficult situation. Often the only solution is to merge with another scheme or to go under and leave members with unpaid medical bills.”