Medihelp hikes medical aid prices by 16%

Medical aid scheme Medihelp has announced that it will increase its plan prices by an average of 15.96% from January 2024.

The scheme said that the hike comes as the business returns to normal after the Covid-19 pandemic and offsets three years of lower price hikes.

It said that growth in its membership has also added pressure to the scheme’s reserve levels, necessitating the hike.

The group said that the decision to hike contributions by 16% was not an easy one to make, but stressed that it was the responsible thing to do, given the reserve levels. It also did not want to cut benefits or reduce contributions to savings accounts.

Medihelp said the 16% hike also comes in the context of the average adjustments over the past three years, where prices were adjusted by 5.8% in 2021, reduced by 0.45% in 2022 and hiked by 7.2% in 2023.

“The majority of Medihelp’s options are currently priced lowest in the market, which provides a very low base for adjustment and ensures that the product range remains well-positioned despite the increase,” it said.

“Medihelp is well aware of the impact it will have on members, (but) it is the responsible decision.”

Earlier this year, the Council for Medical Schemes (CMS) recommended that medical schemes cap their contribution increases for 2024 at 5.7%.

Yet, none of the medical schemes could accommodate this, especially since medical inflation is about 3% higher than the current consumer price index (CPI) of 4.8%.

Product changes

Medihelp’s product range for 2024 will thus remain as is, offering comprehensive, savings, and vital plans, including:

• An unchanged premium structure where families will continue to benefit from paying for only two babies, toddlers, and teens on MedVital, MedAdd, and MedPrime.

• Child dependant rates will continue to apply to child dependants until they reach age 26, and MedElect will still provide student cover for under R1 000.

• The full basket of preventive care benefits on the vital, savings, and comprehensive plans will remain intact in 2024, as well as the care extender benefit, which has paid out more than R4,5 million in benefits for the year thus far.

In addition, Medihelp will be implementing additional care initiatives in 2024 to support members in seeking the best health outcomes.

These include:

• Establishing CoCare Centres of Excellence. It will consist of care baskets for specific procedures that will drive down the overall cost of health interventions. Members applying for pre-authorisation can use this alternative and benefit from fewer out-of-pocket expenses.

• A benefit package for treating major depression instead of hospitalisation since, on average, 116 members are admitted to the hospital per month to treat major depression.

• A back and neck rehabilitation programme through Documentation Based Care (DBC). Members will not be liable for co-payments if the DBC treatment programme or alternative treatment is followed and surgery is clinically justified and authorised.

• Drug-gene testing or pharmacogenomics to assist high-risk patients in ensuring that the right medication is prescribed for their conditions.

• The disease management programme will be integrated with the Member Zone to assist members in complying with treatment and managing the risks associated with these conditions.

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