BizCommunity – 10th January 2024
Source: James White, the director of sales and marketing at Turnberry Management Risk Solutions.
Medical schemes review their policies annually and make changes for the coming year. This may include enhancements to cover, reductions in cover, changes to the way things are covered, additional co-payments and sub-limits, and more. It also includes premium increases, which vary according to the medical scheme and the plan option.
Understanding these changes and how they affect you is critical in ensuring you maintain the best level of cover to meet both your needs and your budget in 2024 and beyond.
The Council for Medical Schemes regulates increases to medical aid premiums, allowing for an average increase of approximately the Consumer Price Index (CPI) plus 3%. However, as this is a weighted average increase, and CPI fluctuates, this only gives a general indication of what price increases can be expected for 2024.
CPI is currently around 6%, which means the average medical-scheme contribution increase will be around 9%, but some plan options have lower increases while some are increasing by a massive 20%.
Changes in cover
Another thing that changes every year is how things are covered by medical schemes. Again, this depends on the scheme and the plan option. New treatments may now fall within the cover of the medical scheme, and in some cases, benefits may be increased. In others, there may be increases in existing co-payments as well as additional co-payments that will become applicable for procedures that were previously covered.
There may be increases in the penalty amount for using non-Designated Service Provider (DSP) doctors and hospitals. There may also be additional or increased sub-limits for procedures, and some plans may have additional exclusions that previously did not apply.
Meeting your needs
There is no universal change that is applicable across medical schemes and plans, as it is entirely dependent on the option selected and the provider. It is therefore critical to examine your individual plan option and understand what will be changing. This will allow you to find out exactly how much the contribution will increase by for 2024 so that you can accurately budget, and how your cover will be different, and if it still meets your needs.
Once this is understood, you will be able to make changes if necessary. It will also allow you to see where gaps exist and help you to choose the right gap cover to augment your medical-aid plan and option.
If downgrading your medical-aid cover becomes necessary, shoring up these gaps with gap cover becomes even more important. However, this is an incredibly complicated landscape, and understanding the changes is not always easy. It is important to talk to your broker to make sure you get the right advice and can make any changes necessary before the end of the year.
What is Gap Cover?
I had excellent service from your claims department and a swift payout to cover my shortfall with an Orthopaedic Surgeon. I would recommend Turnberry to anyone considering Gap Cover as it is an essential addition to your Medical Aid. Turnberry service definitely rates a 10. Cecilia
I was diagnosed with stage 3 colon cancer last year June at the age of 39. Never expected that! Also not the medical expenses. The specialists at the hospital close to me and approved by my medical aid referred me to Donald Gordon Medical Centre’s colorectal unit which is not on the list of approved hospitals. I have had 2 major surgeries and having another soon. I was also hospitalised for a 2 weeks (8 days in ICU) for a bacterial infection in my colon. I am grateful for the fantastic doctors who saved my life but I had massive co-payments and shortfalls that wasn’t covered by my medical aid and that is where Turnberry absolutely saved me, EVERY TIME. I am now cancer free and it made my battle with cancer so much easier not having to worry about medical expenses. I have heard many stories about gap cover (not good ones) and I therefore believe that I have the best gab cover available. I just wanted to say thank you and the service is GREAT. Marlise