Many medical schemes have boosted their benefits for 2023, including reduction in co-payments, increased access to GPs as well as a focus on preventative screening.

According to Dr Ryan Noach, CEO of Discovery Health, the Covid-19 pandemic caused many people to defer any healthcare needs that were not related to Covid.

This meant that lots of medical scheme members missed essential preventative screening and health checks. Discovery Health’s data clearly shows that screening rates among members are worryingly below pre-pandemic rates.

According to Discovery’s data, general health checks are down 50%, mammograms down 15%, pap smears down 12% and prostate cancer screening checks are down 10%.

“When it comes to diseases such as cancer or any form of chronic illness, early detection is fundamental to limiting serious complications and reducing costs in the long term. For example, our data confirms that on average, a person diagnosed at the age of 40 with an early-stage breast cancer has a three times higher likelihood of surviving for five years post diagnosis.”

Effective 1 January 2023, Discovery Medical Scheme will make its excess solvency reserves available to fund an expanded range of screening and preventive healthcare for members through the new WELLTH Fund.

The Scheme will complement this introduction with a unique new Disease Prevention Programme to proactively identify and support members with elevated health risks.

Through deploying excess solvency within the scheme to the benefit of members, all members will have once-off access to up to R10,000 per family for an expanded range of screening and preventative healthcare to be used during 2023 or 2024. Discovery also announced an increase in the limits for oncology treatment.

Bestmed has added additional preventative benefits for members over the past few years.

Preventative screening reduces costs

“Preventative healthcare empowers people to take a proactive approach to manage their health, providing far-reaching and long-lasting health benefits. This also assists in reducing costs for the scheme, which bodes well for future pricing of contributions and benefit enhancements,” says Leo Dlamini, principle officer of BestMed Medical Scheme.

The enhanced benefits of 2022 will continue. These include co-payments removed on Beat options in-hospital, cover of mammograms on all options, only the first three children paying contributions, improved optical benefits, the child dependant age increased from 21 to 24 years, and reduced co-payments on non-formulary medicines across all options.

These include vaccinations, mammograms, paediatric immunisations, female contraceptives, a back and neck programme, and baby growth and development assessments.

Medshield announced decreases in co-payments for non-formulary chronic medication as well as specialised radiology and PET scans. They are also removing the co-payment on wisdom teeth extraction in a day clinic.

The scheme announced unlimited GP consultations for selected conditions once a member’s day-to-day or savings allocation has been depleted.

Bonitas has restructured benefits to be unlimited for PMB cancers, on all options. The scheme has introduced a benefit of R51 000 per family per year for an insulin pump or continuous glucose monitor for type 1 diabetics over 18 years.

The scheme has also amended its rules to allow members to use their savings as they deem fit for the new year. This allows members flexibility as they can use their saving for co-payments and avoid out-of-pocket expenses on certain plans.

Momentum Medical Scheme expanded its GP visits from the Evolve Option to the Ingwe Option. A sports injury treatment benefit was also added to the Evolve Option.

So be sure to check the changes to your plan to make sure you are getting the most out of your benefits.

This article first appeared in City Press.