South Africa: LMS options ensure excellent value for money
In tough economic times, medical scheme members not only want exceptional value for money in terms of medical cover, they also need the assurance that their medical scheme is financially strong and sustainable and able to look after all of their healthcare needs effectively and prudently.
“As custodians of our members’ contributions, it is our duty to facilitate the best quality healthcare possible, taking their financial means into account. Members need to remember that all profits go to themselves in the form of reserves or to keep future contribution increases as low as possible. To ensure that members continue to get the maximum benefit from their plans, now and into the future, we’ve done everything possible to minimise the 2013 premium increase to an average of 11%, in line with medical inflation which currently stands at 10,5%,” says Liberty Medical Scheme (LMS) Executive Principal Officer, Andrew Edwards. “So putting this into perspective, 46% of our members will have an increase of below 10% while 59% of members will have an increase of below 10.7%.”
This is based on the benefits offered by LMS, which will be increased by CPI across the board. “It has always been our stated objective not to reduce benefits to artificially manipulate the increase. Members will therefore gain from an enriched benefit pool which offers excellent value for money,” Edwards says. He further states: “Members will have the added benefit of additional GP benefits, with Liberty Medical Scheme developing an innovative GP Network, which caps members’ exposure to uncontrolled charges.”
With regard to the annual premium increase, he points out that in an environment where the main focus tends to be on spiralling healthcare costs, sight is often lost of the fact that over the last five years, the quality and standard of healthcare in private facilities has also vastly improved, benefiting hugely from major technological improvements. During this time LMS benefits have also increased significantly.
He adds that LMS continues to maintain healthy reserves in line with the legal requirement of 25% as set by the Council for Medical Schemes. An extremely positive credit rating of AA- by the reputable international rating agency, Global Credit Rating Company (GCR), also gives members peace of mind about the scheme’s sustainability and longevity.
Moreover, the scheme’s non-healthcare expenditure is not only below the industry average, administration fees have effectively decreased over the last three years, clearly demonstrating prudent administrative and financial management, Edwards points out.
During the year, LMS has also significantly increased its portfolio of options to best cater for the needs of all its members. On the one hand, the Select options were introduced in May for members in need of more affordable and relevant cover, saving members between 10% – 13% on their contributions.
“In developing these options for healthier entrants, LMS wanted new members to have the same access to quality care, but in a way that was even more affordable,” Edwards explains.
On the other end of the spectrum, LMS has also introduced its Prestige option for members who want absolute freedom of choice of healthcare provider at the highest rate of reimbursement.
Besides a range of extraordinary benefits, preferential service approach and cover up to 3 times the recommended tariff for specialist consultations in- and out-of-hospital, Prestige covers all benefits from risk, unlike other options with a savings component.
What also sets Prestige apart is a dedicated service consultant for each member, 24/7, 365 days a year.
“Our members have identified a need for options at each end of the spectrum – from discounted to high-end. By offering a more comprehensive range of options than ever, we have listened and responded meaningfully to their needs,” Edwards argues.
At the same time, in line with Government’s objective to make healthcare more accessible and affordable for all South Africans, LMS, through various innovative initiatives and measures, as well as prudent managed care, consistently works towards driving down costs to the benefit of its members.
“LMS options are designed in such a way that a number of preventative care benefits are paid from risk rather than from the members medical savings accounts. A preventative care benefit is only a benefit if a member doesn’t have to pay for it, therefore, it should be included in the risk pool, which makes your savings last longer,” Edwards stresses.
Moreover, in specific options, on LMS, a number of additional benefits such as crime trauma support, ultrasound during pregnancy and MRI/CT scans, are also paid from risk. “Again, we wholeheartedly agree with Government on the importance of preventative care to contain costs, which may well be incurred further downstream because of extensive curative care.”
In addition, LMS offers members a host of option specific benefits such as cover for professional sports and hazardous pursuits, basic and advanced dentistry, cover for chronic medicines and immunisations, unlimited oncology benefits, and unlimited casualty/emergency room visits. In addition, LMS charges only for the first three child dependants, while full-time students up to the age of 26 pay children’s rates.
“Going forward, LMS will continue to develop innovative new products to meet members’ needs, emotionally, physically and financially, thus rising to the challenge of spreading their funds in the most equitable way possible,” Edwards concludes.
