Medical Aid Year End Revision


It is that jolly time of the year again to review your Medical Aid Health plans for 2022!

Deadline for plan changes

  • Discovery Health - Individual Members by 15 Dec 2021 and Members on an Employer Group by 30 Nov 2021

  • Momentum Health - by 30 November 2021

  • Bonitas - by 30 November 2021

  • Fedhealth - by 30 November 2021

Discovery Health was the only Medical Aid that offered all Health members a 6-month premium freeze on increases until 01 July 2021. This Offering allowed the Discovery Health Medical Scheme to use some of the Reserves, about R2.2 billion towards the components that contribute

towards the Premium increases of each year like claims utilisation and the administering and successful rollout of the COVID-19 Vaccinations across the country.

Going into 2022, Discovery Health has decided to offer the Health Members a 4-month premium freeze on increases until 01 May 2021.

Components that contribute to the annual Medical Aid Premium Increases:

  1. The CPI tariff rate is about 4.4%.

  2. Demographic Risk - Ageing and Chronic Demographics 3%.

  3. Utilisation Changes - COVID related and non-related claims 1.5%.

  4. Risk Management - Utilisation of Vitality reduces this Risk.

  5. Medical Inflation with the above components in mind leads up to a 7.9% premium increase from 01 May 2021 across all plan types.

Discovery Health Medical Scheme Benefit updates for 2022

  • Enhancements to the Assisted Reproductive Therapy Benefit: cover to include treatment related to cryopreservation, embryo freezing, and egg donated cycles.

  • Updates to the Allied Therapeutic and Psychology Extender Benefit: to include severe strokes and head injuries.

  • Enhanced Palliative Care Offering: to provide unlimited cover for Palliative and end-of-life care for both Oncology and non-Oncology Patients with Advanced Illnesses.

  • Precision Medicine for Oncology: expanding access to high -cost treatments for specific Cancers to all plan options.

  • Enhancements to the Trauma Recovery-Extender Benefit (TREB): will apply to all plan types, with entry criteria to include a high acuity admission in high care or ICU for defined traumatic events. Families will have cover for up to 6 counselling sessions.

  • Basic Dental Trauma Benefit: excluding Essential Smart and Keycare plans, cover for partial or complete loss of one or more teeth as a result of an accident or injury.

  • Management of all Chronic Disease Conditions: from 01 Jan 2022, members must nominate a Primary GP to manage all their PMB Chronic Conditions.

  • Delivering Hospital: level of care at home for COVID-19 Patients – using the Bio Beat Monitoring device to monitor Vital Movement ,ECG, Pulse rate, Respiratory rate, Blood Pressure, Temperature.

  • Digital Patient Communities: My Diabetes Programme, My Heart Disease Team, My Long COVID Team.

  • Discovery Pay, Via Discovery Bank: using QR codes at the Pharmacy, Hospital and 6500 GPs to pay for claims.

  • Vitality Pay as Go Gym Benefit: from as little as R75 entry level to R100 flagship per visit ( 3 free visits upon activation) via Virgin Active and Planet Fitness.

  • Vitality Travel: Get at least 10% Discounts on all bookings through the Vitality Travel Platform.

As per the Council of Medical Schemes, communication CMS Circular 42 of 2021 “…with some schemes adopting innovative pricing strategies such as keeping premiums constant for a few months and providing much needed financial support to households.”

This circular has attracted other Medical Aid Schemes to offer similar premium freezes on increases for the year 2022 and to encourage utilisation of the Schemes Reserves.

Momentum Health offers members a first-time premium increase to all Health members for 2022 until 01 Sept 2022, increases range from 5.2% to 6.4% across plans.

Fedhealth will offer members a premium increase to all Health members for 2022 until 01 April 2022, increases range from 5.5% to 6.9% across plans.

Bestmed’s premium increase of 4% are from effect 01 Jan 2022 ( no premium freeze for 2022)

Bonitas premium increase of 4.8% are from effect 01 Jan 2022 ( no premium freeze for 2022)

Contact us:

Phone: 011 803 9686

Email: vivian@pbafsa.co.za or bev@pbafsa.co.za


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