“One of the big questions the finance minister faces this year is whether to do away with the modest tax credit taxpayers receive for their medical aid payments. Government is eyeing an estimated R25bn in funds from scrapping these tax credits, to be used to fund the incoming National Health Insurance scheme, says Rob Cooper, director of legislation at Sage.
On Sunday 10 June, 20,000 runners will gather in the early hours of the morning in Pietermaritzburg for the start of the Comrades Marathon. For those who have entered and qualified for South Africa’s most prestigious ultra-marathon, it will be the culmination of long hours on the road training for this big day. Once that gun is fired they will need strength, determination and guts to tackle the 89km ‘down-run’ to Durban to cross the finish line before the cut-off time at 5.30pm. The Comrades is a race that is known for pushing athletes to their limit, its camaraderie and contribution to charity.
Major sponsor, Bonitas Medical Fund, is again part of the supporting team making sure that pre-race, on the day and post-race assistance and guidance is given to the athletes striving to achieve their goals. Bonitas has been part of the Comrades ‘team’ for over a decade and an integral part of the medical aid schemes’ sponsorship includes the co-ordination and hosting of the countrywide Novice and Woman’s seminars as well as the ‘general training’ Comrades roadshows.
These interactive seminars include tips and advice on training, rest, nutrition, hydration and pacing. Athletes are able to hear from, talk to and ask questions of a panel of experts from fields as diverse as sport psychology, medicine and dietetics. Official Comrades Coach, Lindsey Parry, will also be on hand to provide invaluable advice about the route, the psychology of the race and what to expect at the start and finish.
Bonitas has never wavered in its belief of celebrating ordinary people doing extraordinary things. ‘Completing a Comrades marathon is an achievement and we support and champion these athletes,’ says Gerhard van Emmenis, Principal Officer. ‘As a South African company that promotes quality healthcare the fit with this ultra-marathon is a good one. It gives us the opportunity to talk about making better wellness and lifestyle choices and to encourage people to pursue and achieve their goals.’
‘With the Comrades Marathon 2018 theme being ‘Asijki – No turning back’ we are even more determined to be with the runners every step of the way as they make it to the finish line in Durban.
Cheryl Winn, Chair of the Comrades Marathon Association (CMA) says, ‘We continue our quest to stage a memorable ultra-marathon not only for the participating athletes and the spectators along the route but also the millions watching it on television across the globe. It is one of the most inclusive sporting events in South Africa, with a big heart and always gives back to society. That makes us proud.’
‘Our partnership with the Comrades is a long one and we are pleased to have shared the journey with so many athletes and supporters over the years,’ says Van Emmenis. ‘For us it goes beyond the branding and logo rights. It’s about sharing in the passion of the race, celebrating the tenacity of the runners, being part of a legacy that supports true grit and determination as well as a helluva lot of preparation and being able to give back to charity. It’s a winning combination.’
The Comrades Marathon Amabeadibeadi Campaign consists of six official charities, namely: CHOC (Childhood Cancer Foundation South Africa), Community Chest Durban and Pietermaritzburg, Hillcrest Aids Centre Trust, Hospice Palliative Care Association of South Africa, Wildlands Conservation Trust and World Vision South Africa.
For details of the Bonitas Comrades Roadshows, The Bonitas Comrades Novice Seminars and The Bonitas Comrades Women’s Seminars go to the official Comrades website www.comrades.com or download the Comrades Marathon App.
According to Discovery Health CEO, Dr Jonathan Broomberg, efforts to curb fraud in the healthcare system resulted in R568m recovered on behalf of client schemes in 2017, compared to R405m in 2016. Further, fraud-control activities in which health professionals and others contemplating fraud desist from committing fraud in reaction to visible policing and action by Discovery Health, prevented additional fraud to the value of approximately R3bn over the last two years, adds Broomberg.
Discovery Health CEO, Dr Jonathan Broomberg
Discovery Health has invested substantially in fighting the scourge of healthcare fraud. Efforts include the deployment of a specialised team of over 100 analysts and professional investigators as well as a proprietary forensic software system that uses sophisticated algorithms to analyse claims data and identify any unusual claim patterns. Invaluable tip-offs from whistleblowers also help to identify fraud.
The volume of cases reported to the forensic unit continues unabated with the trends of the top offenders, provinces and types of offences remaining relatively unchanged. Gauteng (2,595), KZN (916) and the Western Cape (773) had the highest number of fraud cases reported in 2017 with the Northern Cape (5) having the least number of fraud cases reported in 2017.
The vast majority of healthcare providers are honest, hard-working, highly ethical people who deliver diligent care to their patients. However, analysis of forensic investigations reveals that a minority of healthcare professionals committed fraud against medical schemes, resulting in significant costs to schemes and their members. Discovery Health data also shows that general practitioners and pharmacies are amongst the top offenders while paediatricians and ophthalmologists had the lowest number of cases reported in 2017.
“Medical aids are not-for-profit entities, solely funded by member contributions. This means that schemes have finite resources from which to pay member claims. The burden of lost funds as a result of fraud would be significantly more serious in the absence of our rigorous approach to investigating potential fraudulent behaviour and dealing decisively with fraud when it is identified. Without this rigorous approach, fraud depletes the available pools of funds needed for healthcare treatment for members, and also drives up premiums,” explains Broomberg.
Types of offences perpetrated against medical schemes
The main offence in 2017 was claims submitted for services not rendered for medicines and medical devices never supplied. A common trend in 2017 involved pharmacies supplying members of medical schemes with non-claimable items such as baby formula, nappies, cosmetics and shoes yet submitting claims for prescription medicines. In other instances, medicines or services are supplied to non-members and are then claimed using a member’s medical aid card. Sometimes pharmacies or doctors dispense generic medicines, yet claim for higher cost original medicines.
Discovery Health has also exposed doctors who admit healthy patients to the hospital and submit false claims on their behalf to both their medical aid and to the member’s cash-plan (a lump sum, cash pay-out that helps to pay for any shortfall in hospital fees covered). The proceeds received by the “patient” are shared with those in the fraud syndicate.
Fraud threatens the future of healthcare
“Discovery Health has invested substantially in fighting the scourge of healthcare fraud. Although we have secured large recoveries as a result of our fraud avoidance efforts, we believe that this is only part of the story, and fraudulent activity and billing abuse most likely costs medical aid schemes several billion rands per year. These precious funds could be used to pay for the critical healthcare needs of our medical aid members,” explains Broomberg.
Alongside a host of other local medical aids and their administrators, Discovery Health is working closely with the South African Medical Association and other industry bodies to ensure zero tolerance for fraud, and to ensure that all offenders are brought to book. “As a criminal offence, healthcare fraud not only tarnishes the good name of honest health professionals but is a grave injustice against medical aid members, driving up premiums and depriving them of benefits,” adds Broomberg.
It’s 2018 and if your company is not thinking about embracing the global paradigm towards customer centricity, then you should spend your remaining profits on building a time machine. You’ll need it to review all the moments that lead to your demise.
To retain customers from hungry new entrants and progressive competitors, companies need to transition their thinking from how they can extract the most profit from their “historically loyal customers” to how they can better satisfy their customers’ needs and provide them with a world-class customer experience.
In short, to remain relevant and competitive in this paradigm companies need to become customer centric.
South African companies have been slow to realise this paradigm with almost two thirds of companies (63.4%) in South Africa believing disruption and innovation will have little to no impact on their operations. Either they did not hear what happened to the likes of Kodak and BlackBerry or they are comforted by the scary statistic stating that 80% of new businesses fail within their first year, therefore posing no threat.
However, those that have embraced the paradigm and gravitated towards customer centricity have reaped the benefits and expanded their market share. Two local examples are Yoco and Capitec, which have disrupted the banking industry. Yoco is currently the fastest growing independent mobile point of sale player in South Africa. In under ten minutes anyone can sign up to accept card payments. Capitec has recently eclipsed ABSA as the second largest bank in South Africa. A colleague recently shared their experience of signing up for an account at Capitec; 14 minutes after walking in the door they left with a fully registered bank account. By placing the customer at the heart of their organisations they have continuously exceeded their customers expectations.
Transitioning a company towards customer centricity involves adopting a new way of thinking premised in the new paradigm. Unfortunately, traditional consulting methods remain focused on the bottom line and cannot successfully convert a company towards customer centricity.
In order to transition into the new paradigm South African companies need not break the bank.
Here are two simple ways companies can transition to customer centricity:
1. Starting with why
Few businesses know why they do what they do. However, as discovered by Simon Sinek, all great leaders and companies know exactly why they do what they do and they communicate it thoroughly. They do so because they know that people buy why they do things and not necessarily what they do. Therefore, if people believe in why you do things, they’ll be far more open to any future products you offer. Watch his Ted Talk here.
A classic local example is Discovery. They do what they do because they believe people should live healthier, enhanced and protected lives. This has allowed them to diversify their value propositions and expand their market share horizontally from healthcare to banking, without altering the identity of their brand. Whereas their competitors who focus on what they sell (medical aid) have struggled to offer their customers anything else.
2. Embrace design principles
In 2004, a Design Value Index was created comprising of 16 public companies (these included Apple, Coca Cola, P&G, Walt Disney and Starbucks to name a few) to track how they performed relative to the S&P 500 Index (SPX).
What these companies had in common was that they were considered to be customer centric and have design principles, such as empathy, teamwork or collaboration and testing new ideas at the core of their operations.
The results show that over the past 10 years customer centric companies have maintained a significant advantage, outperforming the S&P by an extraordinary 211%.
The most recent addition to the Design Value Index is the previously engineering-centric company SAP whose co-founder Hasso Plattner, after reading on article on IDEO in 2004, became convinced that a customer-centric approach was the best way to tackle complex challenges and make his software more intuitive and easy to use.
However, embedding design principles is not without its challenges. Traditional companies are notorious for having siloed structures where departments operate independently to minimise risk. These companies also have heavily layered governance structures and strict methods of ensuring accountability.
As a result the key design principles of collaboration, empathy and testing new ideas are challenged because collaboration between business units is not facilitated; customer insights are often disregarded by decision makers because they never engage with customers; and few employees are willing to support new ideas out of fear for being criticised if the idea fails.
These challenges are the reasons why traditional companies and their internal innovation teams struggle to successfully develop innovative value propositions faster than their customer-centric peers.
To embrace design principles and become customer centric I believe companies should:
- Embrace the 70:20:10 rule – made famous by the ex-CEO of Google, Eric Schmidt – which states that companies should spend 70% of their time on their core business and satisfying existing customer needs, 20% on testing new ideas and 10% on exploring new markets. Unsurprisingly, spending most of your time on delivering an existing value proposition with excellent customer service is often enough to secure your market share and prevent disruption.
- Entrust the remaining 30% of innovation to an external innovation partner who can develop and test new value propositions without being slowed down by the aforementioned challenges. (Preferably an innovation partner whose teams have been trained in the principles of design thinking by a reputable institution. One such institution in South Africa, which also does executive training in design thinking, is the Hasso Plattner Institute of Design Thinking at the University of Cape Town, commonly known as the ‘d-school’.)
- Encourage their employees to become vocal about customer challenges and be empowered to tackle these challenges themselves through using the design thinking methodology in sessions facilitated by the innovation partner. These sessions will ingrain design-led innovation principles in all employees, thus slowly transitioning the company one employee at a time.
- Encourage decision makers to go on customer immersions to listen to their customers and understand their needs first hand. Since this is not always possible, one can follow in Amazon’s footsteps whereby CEO George Bizos insists on keeping an empty chair in every board meeting to represent the customer.
Finally, when it comes to implementing solutions, South African corporates looking to make a difference can do so by turning to small businesses, in their enterprise and supplier development programmes, that are eager, underutilised and looking to remain relevant in the supply chain. For those solutions that do not make it to fruition, corporates can make them open source so that other companies with similar customer challenges may implement them. After all, wouldn’t it be great to contribute to a world where all customer needs are satisfied?
We entered 2017 reeling from a series of double-digit medical insurance premium hikes. It was becoming clear that schemes are in trouble; undercut by unregulated, selective insurance products and forced into tighter and tighter modes of managing care delivered. We were facing an affordability crisis then – that, without serious systematic change, schemes will be unable to derail their progression towards shrinking memberships and eventual collapse.
Dr Brian Ruff
Moving into 2018, scheme’s reserves are under threat, memberships are stagnant and the system continues, for the most part, to tolerate overutilisation of hospital services while failing to invest in strengthening community-level care. Alternative fee models remain tentative and marginal, neither inspiring nor supporting any structural changes in the fragmented way healthcare services are delivered. In light of this, I predict the following for the coming year:
- Too few South Africans can afford medical insurance, and those pools are shrinking as a portion of the South African population (now below 16%). Those who continue to purchase cover do so because of the deterioration of public health services or a serious health condition, and they purchase the lowest cost plan available, with hospital only cover. As premiums continue to rise, with the country under serious economic strain, we will see even less demand for scheme cover. Negative sentiment towards medical schemes will grow due to rising premiums, benefit cuts, increasing co-payments and out-of-pocket spend. Many more people will experience failures of the system; such as denial of needed care until the point of hospitalisation. Patients will continue to be frustrated and confused by the very poor communication between their clinicians.
- Demand will wane, negative sentiment will riseRelative to the stagnant demand for private care, we already have a serious oversupply of hospital beds in South Africa. Yet, investors continue to build new private hospitals and clinics. The structural problems are worsening, not improving. As scheme benefits currently work, many people can only access funding for treatment once they are in hospital. Doctors are happy to admit them, as their claims are then guaranteed to be paid. Too many beds drive a very costly form of overutilisation; every time a service is done in a hospital that could have been done in a doctors’ room, we spend R100 instead of R10. This pushes scheme premiums up and is a key driver of shrinking memberships and low scheme reserves.
- Overutilisation will continue to worsenThe crux of the problem in private healthcare, and what drives the health departments’ intentions to implement a single National Health Insurance (NHI), is schemes’ failure to deliver widespread access to quality healthcare. To date, as purchasers of care for their members, schemes have done too little to develop the community-level services that are required to balance the system and achieve better productivity. If schemes are to secure a place in the transition to an NHI and its management, they will need to put their efforts towards developing the supply of affordable care. They will need to dump the fee-for-service model that pays doctors working alone and axe hospital benefits that support over-utilisation, instead giving a solid boost to out-of-hospital benefit packages.
- Schemes will need to innovate in how they buy care for members
Who will drive needed reforms?
One space in which reform is beginning to happen is amongst groups of practising clinicians, who recognise the fault lines in the current set-up and are seeking better forms of payment; ones that support teamwork and reward outcomes (rather than the number of services performed). This involves forming independent multidisciplinary practices that, with deep knowledge of their community’s health profile, can deliver holistic clinical and social care at the community level. Consulting together and being paid collectively, they can reduce costly hospitalisation by treating their patients in the community and using alternative facilities. As we are seeing in other countries, once these teams and systems mature and grow, they will increasingly demonstrate their value in terms of both reduced cost and better patient health outcomes – giving schemes, businesses and future NHI purchasing committees successful alternatives to the status quo.
About the author
Dr Brian Ruff is the co-founder and CEO of healthcare management company, PPO Serve. After three decades of work in both the public and private sectors, in both clinical and strategic roles, he formed the innovative company to reform the way healthcare is practiced and funded in South Africa.
At the Hospital Association of South Africa (Hasa) 2017 Conference last year, two private hospital chief executives and the head of the largest medical funder in the country laid to rest the myth that the private sector is implacably opposed to universal healthcare.
Dr Dumisani Bomela, CEO of the Hospital Association of South Africa
In their presentations, the chief executives offered practical support to the several interventions identified by the Department of Health as it begins its first steps towards quality healthcare for all – specifically maternal and women’s health, school health, the screening and treatment of paediatric cancer, the elderly and disabled, and mental health screening.
For instance, among other suggestions, Netcare’s Group CEO, Dr Richard Friedland, pointed to his group’s success in developing high volume and low-cost cataract treatments in the United Kingdom, offering to make his group’s expertise available here; and Koert Pretorius, CEO of Mediclinic Southern Africa, suggested that in addition to the private sector making private hospital capacity available to the public sector, it could help erase backlogs in maternity care and various procedures by “undertaking a percentage of these cases at lower cost”.
Discovery Health’s CEO, Dr Jonathan Broomberg, pointed out that while it is important for ongoing engagements and debate around the form of a future healthcare system, including through the committees recently announced by the Department of Health to interrogate various aspects of the National Health Insurance, it is at least equally important to retain a strong focus on delivering immediately on the everyday healthcare needs of what Friedland earlier called an ‘unsustainably unequal’ society.
In other words, while we continue to shape and form through ongoing engagements the future fate of the healthcare system, let us get on with making sure we do the best we can for South Africans today. It is highly likely that as collaborations deepen on everyday healthcare delivery, collaboration on larger issues like the National Health Insurance will become easier, more pragmatic, and less adversarial.
The situation South African healthcare finds itself in is not unique – many others have walked down these admittedly difficult paths. At the conference, Denise Soares dos Santos, who runs one of the largest private sector healthcare hubs in Brazil – and her compatriot Luiz Augusto Carneiro – described how the two sectors have found ways to exist side-by-side, sustainably, against a backdrop of slow economic growth, the need to reform their healthcare system, and the pressing need for social stability in an unequal society. Their journey to this point may not have been untroubled – for one, healthcare inflation ran for years in the double-digits – but Brazil has shown that workable solutions can be found.
Similarly, Dr Vinod Bhat, vice chancellor of Manipal University, described how his country – India – has fashioned success out of collaboration between the public and private sector in expanding training facilities for doctors to meet a debilitating shortage in the profession in that country. As did Brazil, which responded similarly to India, South Africa faces the same challenge in that this country has only half the global average number of doctors – a number that has remained static for decades even as the population has doubled. There are no such partnerships in this country to increase the numbers of medical students – there are no public-private collaborations in South Africa to increase the numbers of doctors in training.
Performance and outcomes
In like manner, a third speaker at the conference, Marine Erasmus, director at Econex, made the point that the cost of universal healthcare debate is a distraction from the need to collaborate to improve on the performance of the healthcare system and its outcomes.
The critical point is that whether we are concerned about the daily healthcare needs of South Africans or the long-term future of the healthcare system in this country, the potential for success is exponentially higher when partnerships exist.
We now have the stated intention of moving towards universal healthcare in the gazetted National Health Insurance, but to move from a stated intention to a realised ambition is another thing altogether.
To paraphrase one conference speaker: having a policy is important, but it is not enough; without collaboration we cannot expect to wake up on the 1 April 2026 (or at some future date) and hope that by some miracle universal healthcare will be in place. Nor, he may have added, will we quickly enough solve the immediate healthcare challenges South Africans face without joining hands today.
A healthy nation is a cornerstone of socioeconomic growth, and besides ensuring basic services such as clean water and sanitation, quality healthcare is also a right. Therefore, a proper approach is ultimately required, and the government is responsible for creating the framework within which healthcare is promoted and and delivered.
There are various health insurance products which are closely linked to the provision of healthcare. One of these is medical expense shortfall insurance, also referred to as gap cover, an insurance product underwritten in terms of the Short-term Insurance Act. This product is designed to cover the shortfall between medical scheme benefits and the rates that private medical care providers may charge. Gap cover is typically only available to those that already belong to medical schemes.
Medical schemes operate on the core principle of social solidarity. These schemes cross-subsidise risk by pooling members from a wide spectrum of the population, for instance young, old, healthy and sick individuals. The contributions of members are universal, depending on the plan you select, the monthly contribution of each member is the same. This is what is referred to as community rating. The benefits within medical schemes are also pre-determined, and includes a list of prescribed minimum benefits, or the conditions (such as hypertension or diabetes) that the medical aid has to cover by law. Anyone that applies for membership can join the scheme no matter their age, health status, race or gender. These mechanisms contribute to the affordability of schemes and provide access to quality private healthcare.
In contrast, gap cover is underwritten by insurers that apply normal underwriting principles in pricing these products, meaning that risk factors such as age, health status, etc. are taken into account to arrive at a price which aligns with the insurer’s risk appetite.
The dilemma is that the availability of gap cover encourages younger and healthier, and therefore less risky, members of medical schemes to ‘buy down’ or opt out of schemes entirely and cover the gap between the benefit under the scheme option and the actual medical expense. The loss of these less risky members from medical schemes tips the scales towards an older and less healthy average member remaining in the scheme and thus impeding on the principles of cross-subsidisation which ordinarily improves the affordability of medical schemes. As a result, medical cover for the older and less healthy members left in the scheme becomes more expensive.
This problem has been amplified, amongst others, by the following:
- Financial advisors earning higher commissions for selling gap cover as opposed to medical schemes products, and
- advisors misleading customers by marketing health insurance policies as alternatives to medical schemes cover.
This ultimately led to the National Treasury (NT) and the Department of Health (DoH), in conjunction with the Financial Services Board (FSB) and Counsel of Medical Schemes (CMS) – collectively referred to as the regulators – putting their heads together to come up with a solution.
There is, however, an alternate view that the target market for health insurance products is in fact those in society who are not able to afford traditional medical aid cover and that consumers take up health insurance products because they cannot afford medical schemes or their existing scheme does not cover their medical expenses in full, leaving them out of pocket to settle outstanding medical expenses.
The Demarcation Regulations
As a starting point, the Financial Services Laws General Amendment Act widened the definition of the “business of a medical scheme”, resulting in the inclusion of some health insurance products. Affected insurers would therefore need to be registered as a medical scheme and need to comply with the Medical Schemes Act (MSA).
As a result, the Demarcation Regulations, made under the Long- and Short-term Insurance Acts, became effective on 1 April 2017. These specify the types of contracts regulated under the Long- and Short-term Insurance Acts and therefore which contracts are excluded from the MSA.
The regulations will allow insurers to continue to provide gap cover products but they must be structured in a manner that complements medical schemes and will be subject to strict underwriting and marketing conditions. Thereby, effectively levelling the playing field for those health insurance products that pose a threat to the medical scheme environment and those products issued by medical schemes.
- A policy benefit limit of R150,000 per insured person per year must be applied across all gap cover products.
- The commission which advisors will receive will also be adjusted. The new regulations provide a sliding scale with 5% being the lowest commission level and 20% the highest commission level. The maximum percentage will apply to monthly premiums less than R300.
- Gap cover has to be underwritten on a group basis, meaning no individual risk rating is applied, and therefore no discrimination based on race, health status, etc., against an individual policy holder is allowed.
- No variation to an individual’s policy can be made as a result of claims experience. Variations can only be made on a group basis as whole.
- There are stricter marketing rules aimed at ensuring that customers are not misled.
The Treasury agrees that more needs to be done to lower the high medical schemes costs for consumers and supports the Competition Commission inquiry into the high costs of private healthcare. The inquiry is essentially an investigation into the state, nature and form of competition in the market and was initiated to determine features of the private healthcare sector that prevent, distort or restrict competition. The NT and the FSB are also working together to improve market conduct practices in medical schemes.
The DoH and CMS are taking concrete steps to develop a low-cost medical schemes option that can be provided under the MSA, in order to ensure that more low-income households can access medical schemes and the government through the DoH and the NDP has realised that it is time for the country to move to universal health coverage where everyone receives the quality healthcare regardless of their economic status and this universal health coverage is envisaged by the National Health Insurance system.
December and the annual migration down to the coast or overseas will soon be a reality for the majority of South Africans as the summer holiday shutdown begins. Most of us are vigilant about our preparations ahead of going away.
Consider travel insurance to ensure you are fully covered in the event of a health scare while travelling. If you are unfortunate enough to have an accident in a foreign country the last thing you and your family need to be worrying about is the cost of hospitalisation.
“Holidays are part of living a healthy lifestyle and we encourage our members to de-stress from the daily grind of life by taking some well-deserved time out,” says Gerhard van Emmenis, Principal Officer of Bonitas Medical Fund. “We urge all our members to ensure they take their medical aid cards with them when they travel locally to ensure that will be taken care of in the case of an emergency. For those travelling internationally, we offer an International Travel on all our plans, except BonCap.”
Medical expenses that you might encounter when travelling abroad can be prohibitively expensive, especially with a fluctuating exchange rate. Van Emmenis says that to avoid having your holiday and finances totally ruined, look at what your current medical aid scheme offers in terms of medical travel cover and, if necessary, top this up with additional travel insurance.
The International Travel Benefit, offered by Bonitas covers medical emergencies when you travel outside the borders of South Africa. Cover is:
- Provided for up to 90 days per trip, irrespective of the number of trips made during the year
- Limited to R5 million per person, up to a maximum of R10 million per family
- Subject to certain exclusions (such as pre-existing conditions which is limited to R100,000 and certain dangerous sports activities)
The benefits include cover for:
- Mandatory vaccine expenses (i.e. when a country you’re travelling to requires certain vaccinations)
- Emergency medical expenses
- Medical evacuation and transport
- Out-patient and in-patient treatment
- Optical and dental expenses
- Travel assist services
What does your medical aid cover?
It is important to check with your medical aid scheme to see what you are covered for and, just as vital, is notifying them of your travel plans. “Members need to activate the international travel cover when they are planning to travel out of the country,” explains Van Emmenis. “The Bonitas cover is underwritten by an authorised financial services provider who need time to activate the policy. Ensuring you have cover prior to leaving will allow the medical aid to provide members with the necessary information needed in terms of vaccinations, as well as who to contact in case of an emergency abroad.”
Paying for travel by credit card
Almost all credit card providers have some form of automatic travel insurance if you use your credit card to book your air tickets. However, this doesn’t necessarily mean that the medical benefits offered will be adequate. Make sure you know what is covered, what the total monetary value for the cover is and where there might be a shortfall.
Travel insurance policies
There are a host of insurance companies and travel organisations – including the AA – who offer travel insurance. Often these are affordable as a form of ‘topping up’ on your existing cover that you have via your credit card insurance or medical aid.
However, if is wise to shop around for a plan that covers all bases, don’t assume that because you have travel insurance you are covered for every eventuality. In addition, check what the claim process is as you might have to keep all records, bills and payment receipted while travelling.
Cover for the adventurous
Although there are various policies you can take out for a short term period, i.e. for the duration of your holiday, you do need to also consider the type of holiday you are going on and the country you are visiting. Good advice to follow to us to check whether there are any travel warnings or restrictions around the city or country you are visiting and plan accordingly. Make sure you have natural disasters covered on your travel plan.
Often perceived dangerous adventure trips for the adrenalin junkie-seeker will not be covered or there will be a surcharge. This means you will need to specifically look at taking out “hazardous activity cover”, designed to cover accidents that could happen but there are limits here too.
“In all honesty, none of us want to think about ill health or possible disasters when we are excitedly planning a holiday,” says Van Emmenis. “But there is nothing worse than being unprepared and in the case of an accident or medical emergency, not only will the holiday be ruined but financially it can be devastating too.”
Life is unpredictable so the best thing you can do before your next holiday is be prepared. Find out what your existing medical aid policy covers, research additional travel insurance options and make sure you have adequate cover and, above all, read all the fine print. Stay healthy and safe these holidays!
Bonitas Medical Fund was recently awarded the Ask Afrika Orange Index for service excellence. This makes it a hat trick for the fund this year, having earlier received both the Kasi Star Brand Award and the ICON Brands Survey award – both for the medical aid category.
The Ask Afrika Orange Index, which started in 2001, measures service within and across 32 industries, using 10 of the most relevant service benchmarks and ranks 165 companies. This ensures a 360 degree view of the service performance of the company while measuring customer and emotional satisfaction and loyalty.
According to Ask Afrika service expectations have changed significantly over the past five years. “Consumers are more sophisticated and have higher service expectations. This, in conjunction with more choice and service channels, elevated access to information and less customer loyalty, not only shapes what consumers know and expect from brands but also how they engage with brands”.
Gerhard Van Emmenis, Principal Officer of Bonitas, says, “As a South African brand that has been around for over 35 years we conduct regular interactions and surveys with members and financial advisors. Through this, we gauge customer satisfaction in order to improve on the delivery of services.
“We appreciate that we need to differentiate ourselves not just through our product offerings but on delivering an efficient service and outcome for our members. We are pleased that our members are positive about both the product and service they receive from us. The increase in satisfaction can be directly attributed to claims being dealt with quickly and efficiently as well as clear, simple, easily understandable communication.”
The fund’s call centre was recently upgraded and additional staff training rolled out to ensure member that queries are dealt with timeously. Earlier this year Bonitas enhanced their website and digital platforms to offer members and brokers more support.
Dental-Ladies named the winner for Top Affiliate Award. They sent us the most traffic from their website during the calendar year.
Centurion Clinic named the winner for Top Merchant Award. They sent us the most client loan applications for the prescribed period.
Dr Charl Marais earned Top Service Award, for being the partner that received the best Nett Promoter Score as rated by their patients, for the same period.
Since inception in 2012, MediFin has financed hundreds of patients throughout South Africa using an online application process, allowing patients to apply from the palm of their hands and keeping the entire process completely confidential. Many patients need to have medical procedures done that fall outside the medical aid scope. This often results in delays on urgent procedures or the neglecting of one’s personal health due to the lack of savings – this is where MediFin assists. We offer finance for expensive procedures making important life decisions affordable, says CEO Tiaan De Jager.
MediFin’s goal is to provide people with the opportunity and financial solution to “Be the best version of themselves” where they may not be in a position to afford the large upfront capital investment of medical procedures. MediFin Financial Services was designed to offer clients a finance option with great flexibility, which includes payment to the doctor directly, a zero deposit, no early settlement penalties, and repayment structures of up to 48 months. Their innovative solution provides clients with an alternative to rising medical insurance tariffs and depleted savings plans and is one of the only options available for elective medical procedures.
This is done through the following means:
Business partner offering:
MediFin has over 400 Medical partners in its network, ranging from dental practitioners, to radiology and fertility specialists, to cosmetic surgeons – just to name a few categories. These medical practitioners have recognised the benefit of partnering with MediFin due to its unique value propositions:
- We pay the practitioner 100% of the procedure cost upfront, improving their cashflow.
- Higher conversion rates – financing patients who would otherwise have declined quotations due to no affordability.
- Improved customer service by not having to turn clients away.
Looking to the future:
In 2017 MediFin increased their financial services offering to include various insurance products. In an
attempt to offer a more turnkey solution to their patients, it was a natural way to offer insurance against procedures that carried slightly more risk than others. They now offer travel insurance, GAP cover and emergency medical insurance which can be bought online in under five minutes – refer https://insurance.medifin.co.za/medifin.
In an effort to further extend their reach, MediFin is looking to partner with great businesses that are pioneers in the medical arena. This is evidenced by their most recent partnerships with Iyeza Health, Ear Institute, Cape Fertility Clinic and MediConnect. MediFin’s online presence and business model continues to prosper as they partner with likeminded companies that share a common vision of putting the patient first.
If you feel that you could benefit from MediFin’s services, kindly contact them on
or call their friendly staff on 0861 000 808.