What's Happening?

Facebook Twitter Youtube Linkedin

NEED HELP? QUESTIONS@FIA.ORG.ZA

become A FIA member TODAY
member login

Rethinking Your Healthcare options for 2021

ARTICLE BY

  • Jacqui Nel

SHARE THIS POST

The toll of a pandemic on healthcare costs and provisioning 

Adapting to a new way of enabling and delivering quality healthcare for members during an ongoing pandemic will be key in the approach of medical schemes in 2021. 

According to Jacqui Nel, Business Unit Head of Healthcare at Aon South Africa, the industry has experienced a mixed bag of effects. One of the positive developments of the pandemic and the subsequent lockdown has been the industry’s ability to adapt to the new normal by swiftly embracing innovative diagnostic platforms. “The use of virtual care consultations with doctors and nurses has increased as did the adoption of telemedicine,” explains Jacqui. 

However, one of the more concerning trends noted by the industry is a marked decline of members going for important preventative care and screening testing, together with a sharp decline in elective surgeries. “Prevention is always better than cure, and the later a patient is diagnosed with a serious illness or condition, the more complex the health implications become, in addition to treatments becoming more costly and possibly more protracted. In the case of critical illnesses such as cancer, a delay in diagnosis and commencement of treatment greatly impacts prognosis and survival rates. The pandemic will continue for months, and for this reason we strongly recommend that members do not neglect their preventative health checks during this time. This includes your mental health. Many medical schemes offer mental health programmes that will enable you to take care of your wellbeing, holistically,” says Jacqui. 

Given the major financial challenges facing consumer households as a result of the lockdown, the affordability of maintaining medical scheme cover is another hurdle facing medical scheme members. The current economic challenges are set to continue well into 2021, and during this time it is vital to ensure that access to quality healthcare and cover are not compromised. 

As financial pressures tighten, many medical scheme members are looking to change and downgrade their benefit options in a bid to save money. “Making the right decisions about the options selected within a medical scheme starts by understanding what benefits will be available and the affordability of the premium attached to these benefits. Benefits that are not covered will have to come out of your pocket, which needs to factor into your decision,” says Jacqui. 

“The Medical Scheme Act currently protects members within the realm of Prescribed Minimum Benefits (PMBs), which enforces cover for 270 diagnosis and treatments of a defined list of chronic conditions and emergency care, assuring members of this cover.  The only precaution to take is to confirm whether the cover falls in the private or public-sector environment. Once that aspect is confirmed, a member can drill down to the day-to-day care offered in a medical scheme option and the subsequent affordability of it,” Jacqui explains.  

While the healthcare industry is certainly rising to the challenge of finding innovative ways of making healthcare provision more affordable – such as virtual care options – it would be naïve to expect all the bells and whistles at a lower price. “At the end of the day it is about ensuring that you have good quality care when you need it most, with the option of adding the bells and whistles back into the mix when it is affordable to do so,” says Jacqui.  

“Some medical schemes offer the option to upgrade benefit options within 30 days of a life-changing event. The peace of mind comes in knowing that a healthcare predicament requiring cover can be addressed at any time when the life changing event occurs. Examples include enhanced oncology; a diagnosis of a severe condition not covered on your current option; or changing a network option in the case of a pregnancy where your specific doctor doesn’t practice within the network of your current option. It is an important aspect to consider when selecting your medical scheme and option of choice for 2021,” she urges. 

By the middle of October most medical schemes would have announced their projected increases for 2021, together with benefit changes and new options. “We strongly recommend that you speak to your healthcare broker to examine your options in order for you to make an informed decision when it comes to finding an option that suits your specific needs and your pocket. Guiding, educating and protecting our clients is at the heart of all that we do,” Jacqui concludes.   

Subscriber Terms and Conditions

  1. APPLICATION OF TERMS
    • These terms and conditions (“Subscriber Terms”) apply to the subscription by any qualifying member of the South African Underwriting Managers Association NPC (“SAUMA”) to the services and benefits offered by FIA Services (Pty) Ltd (“FIA Services”) under the SAUMA affiliation arrangement (“Subscription”).

  2. NATURE OF SUBSCRIPTION
    • A Subscription under this arrangement:
      • does not constitute membership of FIA NPC;
      • does not confer any voting rights or governance participation in FIA NPC; and
      • is governed solely by the contractual relationship between the Subscriber and FIA Services.

  1. ELIGIBILITY
    • To qualify for the Subscription, the applicant must, at the time of application, be a current paid-up member of SAUMA.
    • FIA Services will verify the applicant’s SAUMA membership status with SAUMA prior to activation, and may re-verify such status periodically.
    • If a Subscriber ceases to be a paid-up member of SAUMA, the Subscription will correspondingly be terminated.
    • Applicants are required to authorise FIA Services to confirm their SAUMA membership status with SAUMA as part of the application process.

  1. SERVICES
    • The Subscription entitles the Subscriber to the following benefits:
      • Complimentary access to the FIA CPD Platform;
      • Complimentary access to the FIA Insight Magazine (digital edition);
      • Advertising opportunities on FIA platforms at a discounted rate of 15% (fifteen percent) off the prevailing published rates; and
      • Invitations to attend FIA Technical Webinars annually.
    • FIA Services reserves the right to update, vary or substitute the Services from time to time, provided that the overall value and nature of the benefits remain materially the same.

  1. FEES AND PAYMENT
    • The monthly subscription fee is R260.00 (two hundred and sixty rand) for up to seven registered individuals (Key Individuals and Representatives), and R36.00 (thirty-six rand) per additional registered individual thereafter, excluding VAT.
    • The Subscriber shall provide FIA Services with the required details of each individual to be registered under the Subscription for the purposes of activation and billing.
    • All fees are exclusive of VAT, which shall be charged at the prevailing statutory rate.
    • Subscription fees are reviewed annually in March and may be adjusted with effect from 1 April.
    • Any changes to the Subscription, including but not limited to the number of Representatives and Key Individuals registered under the Subscription, may only be effected once annually during the annual review period in March of each year, with such changes taking effect from 1 April.
    • Subscription fees shall be billed monthly in arrears, unless the Subscriber elects an annual billing cycle at the time of application.
    • The Subscriber shall ensure that all billing information (including contact details, authorised signatories and bank account details) is kept accurate and up to date.
    • Non-payment of subscription fees may result in suspension of access to the Services until such fees are brought up to date.
    • The Subscriber acknowledges and agrees that all subscription fees payable under these Subscriber Terms may be collected by way of debit order, which shall be processed by the holding company, FIA NPC (The Financial Intermediary Association of South Africa), on behalf of FIA Services. Payment to FIA NPC shall be deemed to constitute valid and sufficient discharge of the Subscriber’s payment obligations to FIA Services under these Subscriber Terms.

  1. ONBOARDING
    • Onboarding will be conducted as a Subscription with FIA Services under the SAUMA affiliation arrangement.
    • Onboarding will not confer FIA NPC membership status or any associated rights.
    • Onboarding is conditional on confirmation of the Subscriber’s current SAUMA membership at the time of application

  1. DATA PROTECTION
    • FIA Services will process all personal information in accordance with the Protection of Personal Information Act 4 of 2013 (POPIA) as set out in our POPIA policies.
    • By subscribing, the Subscriber authorises FIA Services to confirm their SAUMA membership status with SAUMA and to process personal information for the purposes of fulfilling the Subscription.

  1. TERMINATION
    • The Subscriber may terminate the Subscription by giving FIA Services one calendar month’s written notice.
    • FIA Services may terminate the Subscription on one calendar month’s written notice, or immediately if the Subscriber breaches these Subscriber Terms and fails to remedy such breach within 14 (fourteen) days of receiving written notice.
    • Termination of the SAUMA–FIA Services affiliation agreement shall not automatically terminate these Subscriber Terms.
    • Termination by the Subscriber shall not relieve the Subscriber of liability for any subscription fees accrued up to the effective date of termination.
    • FIA Services may suspend or terminate the Subscription with immediate effect in the event of non-payment of fees by the Subscriber.

  1. GENERAL
    • These Subscriber Terms are governed by the laws of the Republic of South Africa.
    • Any disputes arising under these Subscriber Terms shall be dealt with in accordance with the dispute resolution provisions contained in the FIA NPC membership terms and conditions, as modified to reflect that the contractual relationship is with FIA Services.
    • Any notices required under these Subscriber Terms may be validly delivered by email to the addresses provided in the Subscriber’s application form, and such notices shall be deemed received on the day of transmission if sent during business hours.
    • The Subscriber may not assign, cede or transfer any of its rights or obligations under these Subscriber Terms without the prior written consent of FIA Services.
    • No variation of these Subscriber Terms shall be of any force or effect unless reduced to writing and signed by both FIA Services and the Subscriber.