Think twice before pausing your medical aid cover

When your income has been slashed drastically or, in the worst-case scenario, dried up, deciding where to spend and where to save becomes critical. In circumstances such as retrenchment, or periods of reduced employment, it may seem like a quick-fix solution to take a break from your medical aid. But during a global pandemic you may want to think twice.

“In a health crisis such as the one South Africans are experiencing at present, it is important that they retain their health care cover,” says Damian McHugh, executive head of marketing and distribution at Momentum Health Solutions. “The peak of infections in SA is still ahead, so retaining cover for you and your family is critical.”

Lee Callakoppen, the principal officer of Bonitas Medical Fund, says a big factor to consider when it comes to Covid-19 medical care is comorbidities, or the coexistence of two or more diseases or disorders.

“The minister of health, Dr Zweli Mkhize, warned early on in the pandemic that SA has a significant burden of non-communicable diseases, or chronic conditions, with diabetes and hypertension topping the list,” says Callakoppen.

According to him, projections are still highly uncertain, but their actuarial team has estimated that 30% of Bonitas’s members are at risk of contracting Covid-19 based on comorbidities. They project that 20% of their members who contract Covid-19 will require hospitalisation and 5% will need treatment in ICU.

Making decisions

Before you make any important decisions, it might be worth considering what options are available to you; what your priorities are, and where you cannot afford to fall short. It is also advisable that you speak to your medical aid provider to find out what they can offer you.

Denelle Morais, Bestmed marketing and communications manager, says they are only able to offer members relief alternatives that are aligned with directives and approvals received from the Council for Medical Schemes (CMS). As such they are currently unable to offer their members payment holidays.

As a statutory body that regulates private health financing through medical schemes, the CMS has been very specific in terms of what financial relief options medical aids are allowed to offer their members during this time.

McHugh warns against cancelling your medical aid — even if your idea is for temporary relief until you get back on your feet. “In general, cancelling policies could result in them being re-underwritten when they rejoin. We would recommend members contact their respective schemes to opt for payment options first before cancelling their cover,” he says.

Levels of cover

You will also have to consider other terms and conditions that may be applicable once you want to reinstate your medical aid cover such as waiting periods, cover exclusion for existing medical conditions and late-joiner penalties.

“Buying down options could be risky, but it’s better than cancelling  your option in totality. Some medical schemes may allow option changes, but a change in options does mean a change in the level of cover,” says McHugh. If you do decide to buy down, it’s important that you familiarise yourself with the terms and conditions associated with doing so.

Deon Kotzé, head of research & development for Discovery Health, says that current members should consider their initial reasons for joining a medical scheme in the first place. Generally, people decide to join a medical aid to reduce the financial burden of accessing private health care — either because they have a medical condition that requires treatment or because they are concerned about the costs of accessing private health care in the future.

“The duration of the Covid-19 pandemic is arguably a time when there is an elevated risk of requiring access to private health care,” says Kotze. “Unless there’s been a change in their health care needs, or their financial means to meet these health care needs without the assistance of a medical scheme, members should maintain their membership of the medical scheme, or at least reduce the cost of that membership.” 

Bestmed’s relief alternatives for members are aligned with the Council of Medical Schemes

In these unprecedented times, Bestmed Medical Scheme understands that many of its members are experiencing the pressure of a decreased household income, or even lack thereof. But it is also clear that medical aid is crucial during the time of a pandemic, such as the current Covid-19 crisis.

As an essential service provider during the pandemic, various alternative payment options were considered in April to support members who were unable to pay their current premiums during lockdown. However, Bestmed is only able to offer members relief alternatives that are aligned with directives and approvals of the Council for Medical Schemes (CMS).

The scheme currently offers a payment relief option that allows members to downgrade to a more affordable option, subject to their savings account not being overspent. Members who downgrade will still benefit from the preventive care benefits and maternity care programme offered across all options.

Bestmed recently received approval from the CMS to offer individual qualifying members, who pay their full monthly contributions out of their own pockets and have at least six  months’ worth of savings accumulated in their vested savings (the amount should be enough to cover at least one full month’s contribution), the option to pay premiums from their vested savings.

The qualifying individual member will have the opportunity to pay their May to December 2020 contributions from vested savings, subject to the above-mentioned criteria being met.

This unfortunately means that corporate members and pensioners will not qualify for the above-mentioned option. However, pensioner members whose premiums are paid from SA Social Security Agency (Sassa) pension grants may request that their debit order be deducted on the seventh of the month instead of the first.

Regardless of their benefit option, Covid-19 diagnostic tests will be reimbursed according to the following criteria and requirements:

• If the member is symptomatic and referred by the service provider for a test, the claim will be paid from the scheme’s risk benefit irrespective of the result.

• If the member is asymptomatic and unreferred for a Covid-19 test, the claim will be paid from the available day-to-day benefits or savings.

• All confirmed, positive Covid-19 tests will be paid as a prescribed minimum benefit.

Bestmed support

It is imperative to remain a member of the scheme and, if the situation demands, to take advantage of a relevant payment relief option. This will help members avoid unnecessary health care expenses, which could cause further personal financial strain.

Bestmed also wants to support members in taking precautionary measures during the pandemic. Members who purchase hand sanitisers at registered pharmacies can submit their cash receipts for a refund.

The medical aid also recognises the need to assist members of the community who are struggling financially during SA’s Covid-19 lockdown. In this regard, Bestmed will also contribute towards Covid-19 relief efforts. The board has approved funds to be allocated towards much-needed food and sanitising supplies, three-layer masks and high-quality cloth pads, respectively, to people in need.

Generous donations

Employees have also been part of the solution and have generously donated R792,231 to a relief fund that will be used for people in need.

The scheme is also grateful for the contributions that their sponsored entities have made to stakeholders. Bestmed Road Rangers have assisted in packing and delivering food parcels to people in need, while Bestmed Tshwane Classic and The Bicycle Company (TBC) Bestmed Club have motivated the cycling community to stay healthy, fit and in high spirits.

Bestmed is committed to helping both scheme members and members of the community in dire need at this time of crisis.

In keeping with their “Personally Yours” brand promise, not only has Bestmed contributed towards helping members of the community, but Bestmed employees have generously volunteered to contribute towards a relief fund, says Denelle Morais, marketing and communications manager for Bestmed.

Consumers who have been hard-hit by more than two months of nationwide lockdown are looking for ways to cut costs.

Sanet Oberholzer spoke to Lee Callakoppen, principal officer of Bonitas Medical Fund, to find out how the fund can assist its members during this time — and why it’s not a good idea to resort to cancelling your medical aid.

What can customers do to get relief without cancelling their plans completely? 

We understand the challenges faced by South Africans during this tough time and are  aware of the financial implications the lockdown has placed on them. We believe that this pandemic reiterates the need for quality health care. Our advice is to consider your specific medical needs as well as your budget when deciding how to proceed.

We don’t think that this is the right time to cancel your medical aid, particularly if you have chronic conditions or are at greater risk — although we understand the financial pressure everyone is facing.

Buying down is definitely a key consideration. Where possible we advise South Africans with financial constraints to consider network options, which can result in marked savings. Our Select Plans, for example, are priced 15% cheaper than non-network options. In addition, we strongly advise that you consider benefit richness against your contributions.

Key questions to ask yourself include:

Does my medical aid offer additional benefits that are paid from risk rather than savings or day-to-day benefits?

Does my medical aid offer alternatives like virtual GP consultations, chronic medicine delivery and online antenatal classes to deal with the concerns posed by the lockdown?

Is Bonitas offering payment holidays in any form?

The Council for Medical Schemes (CMS) regulates the industry and has been specific in terms of what medical aids may and may not do. We applied for a concession to provide some relief to our members. As such, those who require contribution relief can contact us on our dedicated e-mail address: covidindiv@bonitas.co.za. 

We will evaluate each request on an individual basis. At present, our concessions include allowing contributions to be funded from savings. In addition, we have special concessions in place for members who belong to employer groups.

What will the consequences be if members cancel their policies?

Unfortunately, members who resign from the fund would not be able to access health care benefits. There are strict rules and regulations governing the medical aid industry. These rules are in place to protect both members and the financial sustainability of medical schemes. If a member cancels their medical aid, they might be subjected to underwriting when they rejoin, especially if they have not had medical cover for 90 days or more.  

Why is it important for people to prioritise their medical aids?

The pandemic has highlighted the need for quality health care. It’s made the fact that good health is precious a critical factor for all South Africans — and has forced us all to consider this as a priority over other concerns. We shouldn’t compromise our health.

Do you envision the pandemic changing the way medical aids operate? 

Covid-19 has caused us to be more innovative and re-evaluate the way we consult with members. The need for social distancing has meant we created and, in some cases accelerated, access to virtual care — not only for members but for all South Africans — to protect health practitioners as well as patients. We continue to explore new ways to connect with our members to ensure they have access to quality health care at all times.

Are you approaching the business side of things differently? Is this pandemic forcing you to think outside the box?

Our business has had to be agile to deal with the implications of the lockdown for our members. We’re committed to acting in their best interests at all time. We’ve introduced a range of elements to support them on a clinical, emotional and financial basis. These include:

• Introducing free 24/7 virtual care with GPs to all South Africans through the Bonitas app. We’ve had more than 24,000 downloads of the app over the last six weeks.

• Through our partner Pharmacy Direct, offering home delivery of chronic medication and three-month prescriptions. About 187,995 members are enrolled on the chronic medicine programme and of these over 55% use the home delivery service.

• Setting up a dedicated Rapid Response Unit in our managed care team to address Covid-19 concerns and support members who are under investigation or test positive.

• Creating a Covid-19 hub on our website so that members have access to information on the coronavirus and the steps they can take to protect themselves.

• Creating a corporate return to work programme to support employer groups with daily screenings, occupational health and safety, and so on.

• Creating isiXhosa videos to help educate people in the Western Cape on steps to take to curb the spread of Covid-19.

• Launching new self-service channels through the Bonitas app and WhatsApp that allow members to access statements and tax certificates, submit and view claims and access electronic membership cards. There is also a live chat functionality to put you in touch with an agent to resolve queries.

The Covid-19 option provides information on everything from symptoms through to treatment, transmission, recovery, costs covered by your medical aid, frequently asked questions, updated statistics on active cases, recoveries and deaths and a self-screening test.

This article was paid for by Bestmed and Bonitas.