Industry News

Jump in medical cover premiums

11 November 2008

In Categories: Industry News , Industry News > General

GEMS has increased its premiums by up to 11.2 percent but still government employees will be paying far less than members of other medical aid schemes.  Members of the largest op-en medical scheme members will be paying up to 16 percent more for a similar cover.

State employees will pay 11 percent more for medical cover

THE Government Employees Medical Scheme (Gems) will increase its contributions by 11.18 percent next year. For a family of three, this will amount to an increase in rand terms of between R12 and R188, depending on the benefit option and the salary level of the member, according to Dr Eugene Watson, the scheme's principal officer. Watson said the scheme had also adjusted the income bands for its contribution rates, and many members might find that they had moved "down" the income bands. In setting its contribution rates for next year, Watson said Gems took into account the anticipated medical inflation rate for 2009, in light of the current high-inflation environment; the adjustments to public service salary bands; Gems's need to raise its solvency ratio; and the scheme's expected growth in membership over the next year. Since 2006 the government has been offering higher medical scheme subsidies to employees who join Gems to encourage them to move from other schemes. It pays 100-percent subsidies for those who join Gems's lowest-cost option. Gems has grown its membership to 300 000 principal members or 800 000 lives (members and dependants). The rapid growth in membership resulted in the scheme's solvency ratio declining to 8.4 percent at the end of last year. Watson said next year's contribution rates took into account that Gems was growing rapidly and that its membership profile was changing, affecting its claims patterns. He said benefits on the two network options would increase by 10 percent, while benefits on other options would increase by five percent. The scheme is introducing a maternity programme for all members next year. Members of the lowest-cost option, Sapphire, which offers state hospital cover only, will enjoy private hospital cover for maternity care from next year. Gems claims its benefit plans are 10 to 25 percent less expensive than those of other medical schemes with similar or better benefits. Pro Sano, another large medical scheme with over 30 000 members, said its contributions would increase by an average of 11.7 percent next year, with members' increases ranging from 7.5 percent to 16.5 percent. The scheme has launched a new comprehensive option, ProElite, which covers hospital expenses at 300 percent of the National Health Reference Price List rates.

Laura du Preez: Personal Finance, 8 November 2008