Could this be the year things improve for medical schemes?
The industry has had a tough couple of years, but efforts to address some of its troubles might start to bear fruit, writes Roshan Bhana
Only four of SA’s 10 open and top 10 restricted schemes — Discovery Health Medical Scheme, Sizwe Medical Fund, SAMWUMED and LA Health — achieved the required operational surplus (that is, income from contributions that is sufficient to cover all claims and expenses) in 2015. This trend is expected to continue for 2016. Some of the possible reasons for the poor financial performance are: 1. Age profile of members The profile of schemes has changed due to a combination of factors including the issue of ageing members. Only in workplaces where medical scheme membership is compulsory are schemes getting young members as soon as they start work. Rather, the healthy and young join only when they need cover, such as when they start a family or are diagnosed with a health condition. For schemes that have relaxed underwriting, this is an issue. The waiting periods where new joiners cannot claim are not a sufficient deterrent — a three-months general waiting period, and 12 months for specific...
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