SHOCKING AND COMICAL: You have to be in an auditorium when increases are announced and the audience, made up of key executives and medical aid brokers clap and praise the speaker. What has this come too? I feel executives should consider every possibility to reduce and or control these runaway costs on the employee because as it gets worse, the risk will shift back tot he employer in one way or another.

We advocate that executives responsible for the staff’s medical aid, drive a cost reduction project starting today for 2021. This project is the beginning of employees becoming well to the point of not requiring the medical aid benefits as they have today. Yes those major account for hospiital should be covered as they are big ticket items, however the day-to-day can be minimise to almost zero per annum. Rather use the existing spend and invest in healthy foods.

You may be wondering why we would suggest this since we do provide medical aid as a part of our business and eventually we won’t have this funded by the medical aids in the form of a commission, however we would create a service far greater where we are impacting on the lives of every member and the company to control what the pay towards the negative effects of not being well.

Note that according to the Discovery, the weighted average increase last year was 9.5%, with the increases mostly skewed to the higher-end plans, with those in the Comprehensive range and the Executive plan increasing by very close to 17%.

Here we have the top plans, where managers, executives and people who can afford these contributions and presumably are participating on the health plans such as vitality, showing the highest claims and thus the highest increases. The question we need urgently ask is where does this stop and how do we take back our health so that we can take control of the current and future costs.

Following this increase we provide an example where a member’s current medical aid on Discovery Classic comprehensive was to go up to around R23,000 per month, never mind  the self-payment gap he had for 2019 and many out of hospital costs which were not covered. This R23 000 contribution is for a member plus 3 dependents.

By restructuring his plan, he is able to increase his savings and decrease the premium by 45% per month. The client also spends money on supplements above his contribution for which are not paid from the medical aid. Now on another plan, his supplements are paid from his savings account.

Correctly structured according to claims over the prior year, a member could reduce their costs up to 45%. Don’t wait another year for this happen.

For the majority of members, depending on the option selected or medical scheme, a properly structured benefit could show a decrease in premium by at least 20% going into 2020, not another 9 to 11 % increase. If on a medical scheme and you can’t move due to the health risk profile, a properly structured option choice can still reduce you premiums for 2020.

Obviously this depends on the health of the member and where healthy members are paying for the small proportion of unhealthy members, why should this continue? Maybe because of the habit or the medical aid companies dumbing us down each year with a story around why the costs are going up and benefits going down.

Another headline: Salaries not keeping up with medical aid increases

On average, monthly contributions for Bonitas (2ndlargest medical aid scheme in the country) will increase by 9.9% from next year. Adjustments have been made to several health benefits, such as radiology, health, wellness products  to encourage healthy living and maternity care.

Corporate Wellness – Is this a joke in its current form?

There has been a distinct shift towards making employee wellness a serious focus to address work-life balance and maintain employee health. The  approach is to manage the health of the employees proactively by providing access to range of services from Health Risk Assessment, TB screening, optometry, prostate and breast screening, all delivered on site to avoid disrupting the work environment. If the increase are a reflection of the programmes, we need to seriously look at the programme outcomes and impact on costs for the member. Imagine for one second if there were no ‘corporate wellness’ programmes in place.

Let me share a story about an executive who was diligent in his screening however even knowing his status, had no insights how to influence the result. Eight years ago this executive picked up that his prostate (PSA) marker was elevated, hence a potential risk for future prostate cancer. Eight years later instead of the world of medicine turning this around, he eventually had to have his prostate removed and while doing so they cut into other nerves which created further medical consequences. As you can imagine, removing the prostate or any organ of the body,  has many other negative effects in the body. Screening is meant to highlight potential health risks that would enable the person to do something about it before the consequence of the risk impacts on his of her life. That is our mission, why wait for it to happen and then regret not intervening not with medical care, but by changing what has brought it on in the first place.

In our next article we will reveal the medical aid that has had the lowest increase in the market of 8.2%. This medical aid has not only kept the increase to the lowest, but at the same time, has not reduced their benefits. We are waiting on the final documentation to enlighten you on ho this top medical scheme has been able to do so and have its focus on future cost saving.

Don’t wait another year. Take action.

Peter Šmanjak

Owner and Founder at Infinite Risk

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