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Get more bang for your buck from your medical scheme for your employees

Clayton Samsodien

Medical scheme

At this time of the medical scheme benefit year, members have realised the impact of medical scheme inflation on their net disposable income - a scenario exacerbated by, for example, fuel hikes and increased food prices. Cash-strapped consumers – just like your employees - are looking to get more bang for their buck, and this applies to medical scheme benefits as well. The question is how can you help your employees do this?

Unfortunately, the Council for Medical Scheme has recommended that medical scheme contributions increase by CPIX plus 3%. Medical schemes, like other commodities, increase at a higher rate than CPIX. In such an environment, considering the increased burden of non-communicable diseases, we'd be foolish to expect that medical scheme increases will be equal to, or lower than, CPIX. However, we note that contributions increase with CPIX plus 3% yet benefits increase by CPIX. The obvious result is that members' benefits erode over time.

5 Ways you can get more from your medical scheme for your employees

1. Choose carefully how you get reimbursed

Certain medical schemes offer members the choice of having their day-to-day benefits reimbursed at cost - in other words the full amount charged by the provider - or according to the medical scheme rate.

Members who choose cost as the reimbursement rate will inevitably deplete their medical savings account sooner than those who use providers that charge the higher rate. This scenario is called the 'benefit creep'. Reimbursing medical expenses at cost increases self-payment gaps.

2. Find out which providers charge your scheme's rates

Ascertain which providers – including specialists - belong your medical scheme's preferred provider network. This will ensure that the rates charged are the rates paid by the medical scheme, thereby eliminating gaps in cover like co-payments. The more medical scheme members who use these providers, the more costs will be contained.

Educate yourself on your medical scheme's website. Some medical schemes offer services that will ensure your employees aren't out-of-pocket.

3. Choose the most cost-effective medication

There are three medicine types, e.g. ethical, generic and preferred. Advise your employees to ask their doctors to prescribe them ethical and preferred medication because:

  • In most instances, the scheme will pay for this medical in full, and
  • Your employees won't have to pay in part of the medication cost.

4. Your GP can save you money!

Network or capitation options - where members are required to use a network of providers - are becoming popular. On these options, members can only visit a specialist when they are referred by a GP. This means that your employees will only visit a specialist doctor if they really need to.

5. Spending more on diagnosis is a thing of the past

Certain medical schemes provide the functionality where members can give their treating doctors access to medical information. This is extremely beneficial as it will avoid repeat testing.

Clayton Samsodien Clayton Samsodien is the managing director: health care and employee benefits at Genesis EB Solutions, a position he has held for the last seven years or so. He is passionate about developing employee benefits strategies and focuses on bringing a strong voice to the industry. Clayton serves on the board and provides industry analysis and comment in the health-care, retirement fund and employee benefit sectors.