OPINION | Understanding medical aid policy changes for 2024

Medical schemes review their policies annually and make changes for the new year. This may include enhancements to cover, reductions in cover, changes in the way things are covered, additional co-payments and sublimits 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 your needs and your budget in 2024 and beyond.

INCREASED PREMIUMS

The Council for Medical Schemes regulates increases to medical aid premiums, allowing an average increase of about 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 now about 6%, which means the average medical scheme contribution increase will be about 9%, but some plan options have lower increases while some are increasing by a huge 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 applicable for procedures previously covered. There may be increases in the penalty amount for using non-designated service provider doctors and hospitals. There may also be additional or increased sublimits for procedures and some plans may have additional exclusions that previously did not apply.

MEETING YOUR NEEDS

There is no universal change applicable across medical schemes and plans as it depends on the option selected and the provider. It is therefore critical to examine your individual plan option and understand what will change. This will allow you to find out exactly how much the contribution will increase by for 2024 so 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 a 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.

James White, director, is a sales and marketing rep at Turnberry Management Risk Solutions