New GTC Healthcare research reveals that navigating medical aid plan choices is unnecessarily complicated

9 June 2015

Choosing a medical aid to suit an individual or family’s needs remains a daunting task, and unnecessarily so.

“It’s not the wide range of medical aid providers which makes this choice difficult, but rather it is the fact that these providers make it nearly impossible to formulate meaningful comparisons between the different plans,” says Jill Larkan, head of GTC Healthcare Consulting at SA’s established and leading financial advisory business GTC. “We seem to be in a situation where the providers are trying to make their plans more attractive by adding on multiple options which actually ends up making comparisons even more difficult.”

Larkan has first-hand experience of the difficulties which medical aid members face by virtue of the GTC Medical Aid Survey that is compiled by the Healthcare Consulting team on an annual basis. This survey is used to provide the consultancy firm’s clients with advice and suggestions on which medical aid offers best options and value for money for their employees.

The 2015 report by GTC Healthcare is the fifth in the series, and provides analysis and ranking of different medical aid plans, according to the various options available and offered by South Africa’s 22 open medical aid providers.

“If anything, these plans have become more complicated over the years rather than simpler, by virtue of the additional benefits, options and cover choices provided,” she says. “There are a handful of providers that do actually spell out clearly what their different plans offer and what the costs are for additional benefits. But making a comparison with other, more complicated plans requires an in-depth evaluation with informed assistance.

The annual GTC Medical Aid Survey looks specifically at In-Hospital benefits as these represent 60% of all costs carried by medical aid schemes.

Larkan explains that the main difficulty lies in preparing comparisons between different schemes offering additional benefits, as well as the fact that In-Hospital cover levels vary from 100% to 300%.

“Whilst our annual survey goes a long way in assisting and advising which plan is optimal, we seldom have a situation which enables uninformed individuals to comfortably be able to compare apples with apples,” she says. “It would serve medical aid members, and the industry, if we were able to make direct comparisons between plans catering to different needs. At the moment, there is very little clarity on whether even a basic medical aid plan from provider X is better value than one from provider Y.”

She adds that medical aid members deserve the right to be able to make an informed decision, assisted by experienced advisors, based on clear and simple comparisons.

Larkan adds that the basic questions which a member should be able to answer, when selecting a provider and their preferred plan, are: what level of cover do I need both In and Out-of-Hospital, what level of risk do I wish to assume, and, am I willing to restrict my elective hospitalisation to a network of hospitals in order to enjoy lower premiums?

“With the current way plans are presented and packaged, those basic questions can’t be answered without expert advice and informed counsel. It’s vital for members to get the right guidance and expert information before making final choices for their medical aid cover and we encourage employers to help wherever possible to ensure employees feel comfortable with the decisions they make in this area,” Larkan concludes.

The 2015 GTC Medical Aid Survey includes detailed analysis of all plans in South Africa and it has identified the plans that provide the best risk premium across all available options.  Leading plans and providers in the 2015 survey are listed below for the following categories:

• Starter Comprehensive – No Network: Liberty Traditional Standard
• Starter Comprehensive – Network: CompCare NetworX
• Starter Comprehensive State Network: CompCare NetworX
• Starter Core – Network: Discovery KeyCare Core
• Core – Network: BestMed Beat 1N
• Core – No Network: Genesis Private Choice
• Saver – Network: CompCare MuMed NN R 501 – R 7 900
• Saver – No Network: Bonitas Standard
• Comprehensive – Network: Fedhealth Maxima Standard Net
• Comprehensive – No Network: Fedhealth Maxima Basis

Larkan cautions that plan or medical aid provider decisions for individuals, their families or for a company should not be made based on this survey alone.  Advice in this area is complex and requires detailed assessment and support to ensure that all factors have been taken into account.