Bonitas Medical Fund (Bonitas) announced a weighted increase of 8.9% for 2019. “This,” says Gerhard van Emmenis, Principal Officer, “despite a challenging year for the healthcare industry, against a backdrop of uncertainty around the NHI, the recent Health Market Inquiry and current tough economic conditions faced by consumers.

“The past 12 months have been extremely trying, with a number of uncertainties and changes anticipated. In addition, consumers have been heavily impacted by the increase in VAT and escalating prices which resulted from this.”

In July Bonitas announced its financial results for 2017, the best in its 35-year history, with a solid surplus of R730.20 million, having recouped a deficit of R16.9 million from 2016. “This turnaround was due to several key cost saving strategies, says Van Emmenis, “and it bolstered our reserves from R3.1 billion to R4 billion which means that we are able to invest back into the Scheme and offer our members access to healthcare of the highest quality.”

The Fund has announced a number of additional benefits for its members for 2019, while keeping increases as low as possible. “We know that it’s not only the monthly premiums that affect the consumer’s pockets but the value they get out of their medical aid plan,” says Van Emmenis. “Some of the benefits have been tweaked, others increased, one plan has been discontinued and two new options have been introduced, all aimed at helping members take control of their health and lead better lifestyles.”

Working together to reduce healthcare costs

“We continue to seek partnerships with healthcare providers to ensure we are part of the same value chain, rather than being part of the supply and demand of the healthcare economy,” says Van Emmenis. “In addition, we are focused on educating role players to balance the triangle of affordability, quality and cost efficiencies. We are developing an incentive model to motivate service providers to eliminate activities that do not add value to members.”

Over the past few years, Bonitas has taken a multi-pronged approach to cost saving, focusing on:

Hospital negotiations

Hospital claims account for half of Bonitas’ annual claims, around R6 billion a year. For this reason we negotiated a pricing structure with the main hospital groups, to deliver a savings of R242 million last year. We project that this saving will increase to approximately R550 million over the next two years in present value terms.

Managed care

We place great emphasis on our Managed Care initiatives to help members, with chronic conditions, manage their health better. It takes into account the best clinical and treatment protocols while containing costs. Our back and neck, oncology, hip and knee and HIV/AIDS programmes respectively, continue to offer our members emotional, clinical and financial support.

Chronic conditions

The Council for Medical Schemes (CMS) cites chronic conditions – with diabetes in particular, as one of the key contributors to a rising disease burden in South Africa and escalating healthcare costs. 80% of the Scheme’s diabetic patients have associated chronic conditions such as high blood pressure and cholesterol, heart disease and depression which need to be managed on a unique basis. “Through our Diabetes Programme, hospital admissions related to diabetic patients having reduced by 11.6% year-on-year,” says Van Emmenis.

Prevention is better than cure

We have a keen focus on preventative care as early detection is a critical factor in ensuring our members get the support they need to manage any serious conditions timeously.

Women’s health

Last year, we kept a firm focus on women’s health introducing cover for pap smears on all our plans. Since cervical and breast cancer continue to be most prevalent, we have continued our efforts towards early detection by ensuring mammograms for women over 40 will be covered once every two years on all our plans from 2019.

Men’s health

In addition, we have placed the spotlight firmly on men’s health, especially in light of a prevalence of prostate cancer, by adding the prostate screening antigen test to all options for men aged between 45 and 69.

GP network

We have South Africa’s largest GP network which ensures our members get value for money and stretch their benefits. Our online provider locator tool has been enhanced so that members can find network hospitals, doctors and specialists in their area quickly and easily.

Fraud, waste and abuse (FWA)

Our ongoing efforts to reduce FWA have been successful, with a number of convictions and sentencings. This significant focus delivered recoveries of R31.2 million with a potential preventative savings of R75 million. We will continue to ensure that all outstanding money is successfully recovered and repaid to the Fund, so that it can be put to better use to benefit our members.

Going digital

Digital remains a key driver for member and broker communication with Member, Broker and a newly introduced Corporate Zone available on the website. The online application has been revamped, we’ve introduced an electronic membership and a live chat function has been added to assist current and potential members with any questions they may have.

Besides enhancing the Member Zone as from January 1, 2019 members will have access to the Bonitas App – a revolutionary cell phone application that will offer the full benefits of the Member Zone. Making it easier for them to view their benefits and claims as well as submit claims, obtain authorisation, find a network provider, resolve queries and so much more while on the go.

As a value-add for members, Bonitas has aligned itself with strategic partners to offer a comprehensive and holistic solution to help members take care of their financial health and wellness, without paying anything extra. “This is not another loyalty programme,” explains Van Emmenis, “but rather real added value aligned to member needs, with no fee or points scoring.” The model includes a Multi-Insurer Platform offering Medgap, exclusive gap cover with a discount of up to 48% discount for Bonitas members and a wide range of life, funeral, disability cover products through Sanlam Indie with exclusive benefits in the form of free investments up to 110% of monthly contributions. And finally, a variety of free monthly discount vouchers from 30 participating partner retailers through Electronic Line.

In conclusion, Van Emmenis says, “Our plans have been restructured to meet market demand, consumers are looking for options that offer attractive benefits at a more affordable rate.”

Summary of key changes for the year:

• A weighted increase of 8.9%.
• A new multi-insurer platform with exclusive deals and offers for Bonitas members including gap cover.
• Two new plans introduced – Primary Select and BonEssential Select. These use dedicated networks and are both are priced around 15% lower than the Primary and BonEssential options respectively.
• The Hospital Plus plan has been discontinued.
• Mammograms for women over 40 will be covered once every two years across all the plans.
• Prostate screening antigen tests for men aged between the aged of 45 and 69 have been included across all plans.
• Childhood immunisations according to the EPI schedule, are now offered to members on BonClassic, Standard, Standard Select, BonComplete, BonSave, Primary, Primary Select and BonFit – paid from risk.
• The introduction of the My Family Model which contains a full suite of care – such as maternity consultations, 2D scans, antenatal classes, newborn hearing screening – all paid from risk.
• The day-to-day benefits on Primary has been increased by 15% for 2019.
• A family benefits of R31,500 has been introduced on BonEssential for internal prosthesis, it is also included on BonEssential Select.
• BonClassic has been re-aligned to fit in with other options with radiology and pathology combined into one benefit.

For more information on the range of medical plans available from Bonitas, or to compare options, go to www.bonitas.co.za.