Medshield ups benefits and reduces co-payments for members in 2025

Medshield Medical Scheme has launched its benefit options and contributions for 2025, building on its Partner for Life offering.

Medshield remains prudent and consistent regarding annual benefit limits and contribution increases. The 2025 benefit offering and relevant contribution adjustments balance affordability, increase members' access to quality healthcare and ensure Medshield remains a viable and sustainable medical scheme, as evidenced by the latest AA- with a positive outlook GCR rating.

“We are a stable organisation that will be around in the long term, with a selection of member-centric benefit plans to cover members' needs as they navigate through life,” says Kevin Aron, principal officer of Medshield Medical Scheme.

“At Medshield, we work together. We unlock real, personalised value for our members. This value proposition reflects our promise to provide genuine support and meaningful experiences across every member interaction. We always have the members' best interests at heart, being their true Partner for Life.”

Aron says the 2025 product offering has been designed and refined to enhance Medshield's basket of options.

“We increased benefit limits by at least 6% on numerous benefits across all options. We reviewed claim patterns and ensured we increased the benefit limits to provide the best value for members, for example, oncology, external prosthesis and pregnancy scans. Basic and specialised dentistry, optical and day-to-day benefit limit increases alone are more substantial when compared to our average benefit increase for 2025,” he says.

“In addition, the 2025 product offering features a streamlined suite of benefit options to cater for different healthcare needs from birth right through to maturity. We offer eight benefit options and two efficiency discount options, specifically developed to cater for various healthcare needs. It is vital to ensure that members are on the right option to eliminate member frustration and provide the best value in return for the member's contributions.”

Aron says: “Through continuous monitoring of our membership profile and claims experience on the various benefit options, we can determine the specific option's overall performance, which ultimately drives the pricing to ensure that the benefit option remains sustainable. Based on our monitoring and market trends, we have seen growth in the middle-range options, and therefore, the MediSwift benefit option will be discontinued in 2025.,” Aron says.

“The 2025 Medshield offering is characterised by reduced and removed co-payments that minimise out-of-pocket expenses; improved GP networks for an effective patient care journey through care co-ordination; and we are introducing specialist networks. The scheme is also revamping the Medshield hospital networks for more effective alignment to ensure improved access to quality care.”

Medshield followed a carefully considered process to set the rate at which contributions will increase for 2025.

“Among other critical factors, we considered the unit costs at which healthcare goods and services will increase in 2025. The weighted average increase for Medshield benefit option contributions for 2025 is 9.6%,” says Aron.

As Medshield maintains stability and consistency, determining the 2025 contribution adjustment was influenced by several member-centric considerations. 

• Affordability remains important to Medshield to ensure members can retain their healthcare cover (ability to fund their contributions). “Healthcare inflation outstrips general CPI, and the scheme must make provision for that so that we can cover the services rendered to members,” says Aron.

• Increasing access is essential in offering a member-centric service. “By catering for new medical and healthcare technology and effectively enhancing benefit limits, we can provide members with reliable access to quality healthcare and new healthcare technology,” says Aron. “At Medshield, there is a continuous focus on driving service excellence and access to information for members, brokers and our healthcare provider partners, and we are excited to announce the addition of a WhatsApp service line and a revamped Medshield App towards the end of 2024.”

Besides receiving more benefits, members will continue benefiting from Medshield's value-added services in 2025, which include Medshield Wellness, MedshieldMOM and Medshield Kids. 

Innovation is vital to Medshield. One such new innovative value-added offering is the addition of a mental health medicine benefit and the new Medshield Mind support portal — a comprehensive and free web platform designed to provide Medshield members with valuable resources and tools to help them maintain excellent mental health. The platform will be user-friendly and easy to navigate, making it accessible to everyone who wants to care for their mental wellbeing.

To close the gap for medical shortfalls, Medshield partnered with leading insurance brands to market gap cover so members can benefit from lower-than-retail prices.

“As medical schemes, we offer a safety net for many healthcare costs but gaps can occur, especially when the costs of specialists or certain treatments exceed the rates covered by your chosen benefit plan,” says Aron.

“Our collaboration with an additional gap cover partner, Sanlam, is designed to close the gap between a member's Medshield plan and the actual costs incurred, ensuring that Medshield members can access quality healthcare without the stress of unexpected medical bills.

“Besides placing our members at the centre of our business, our employees are crucial in our value offering. Medshield will continue to build a high-performance team to ensure that members of the scheme receive the highest quality service. Our recognition as a Top Employer in SA recognises the value we place on our people,” says Aron.

According to the Top Employers Institute, organisations are evaluated according to entry criteria and then participate in the HR Best Practice Survey to become recognised as a Top Employer. “We are proud of this achievement because this shows that we value people as the core of our organisation. We partner with and value people — whether our staff, our members, the healthcare providers we engage with or the brokers that support the scheme,” says Aron.

“We are excited about the future and can, without any doubt, assure our members that Medshield has their best interests at heart, and our refined 2025 offering will result in easier access to quality healthcare. We are their Partner for Life, through good and not-so-good times.”

This article was sponsored by Medshield Medical Scheme.