Tired of having a gun held to your head by your medical scheme? If yes, then here’s the proven choice.
Let’s get straight to the point. We live in a country where you don’t get much in return for your taxes.
- The cost of food is spiking through the roof
- Municipalities are out of touch with reality when it comes to billing
- You pay a small fortune to educate your children
- Private security companies are paid to do what the police should be doing, and finally
- You pay your medical scheme because state hospitals are not an option
So to balance all this you start off:
- Buying less and less of the luxuries…Steak once a week instead of twice a week
- You shop around for car and home insurance to save a hundred Rand
- You cut your life insurance to the bone or find a cheaper policy elsewhere
BUT…you continue to cough up more every year for medical scheme membership. That’s because:
- You’re dead scared ‘in case something happens’ and
- It’s too much effort to change schemes
- You haven’t had any hassles with your current scheme so far
Listen, I’m with you on this one.
It’s not so much about me, but what if something happened to my son?
Imagine not being able to give him the best possible medical care simply because I wanted to save a few hundred Rands? So, like you, I pay and I pay and I…
But it’s like a massive anchor I’m dragging around, and the truth is I’m always weighing up cost versus benefits.
I’m open to options, but I also don’t want to mess up. Saving R200 a month to end up on a ‘rubbish’ medical aid isn’t an option. Which is why I like the GTC Medical Survey.
So what is the GTC Medical Survey?
Before we answer this question, and assuming you’re not on an employer scheme – what criteria would you use when choosing a medical scheme?
Is your decision based upon?
- Size and reputation?
- Gym memberships and other nice-to-have’s?
- Monthly cost?
- Size of your medical savings account, or
- Hospital benefits?
What if there was a way to compare value for money?
That’s where the GTC Medical Survey comes in. You can download the 2017 report right here.
About a year ago I lost a challenge with Genesis Medical Scheme. Their marketing manager – Elmarie Jensen – challenged me to find a better ‘value for money’ plan than their Genesis Private Choice option.
So first off, I’d never heard of a scheme called Genesis up until this point. What made this medical scheme think they could challenge the big names in the industry?
Long story short, she pointed me in the direction of the GTC Medical Survey. I lost the bet and in return published a series of articles on the Genesis Private Choice plan. I subsequently forgot about them, and hopefully them about me.
Unfortunately, not someone to be satisfied with a once off challenge, she did it again this year. This time I wasn’t going to get caught with my pants down.
The GTC Medical Survey compared 22 open enrolment medical schemes along with one closed enrolment medical scheme –Profmed. Open enrolment meaning anyone can join. Closed enrolment meaning only certain people can join the scheme. They took 144 plans and split them into 11 different categories based on value for money.
In other words, for every Rand spent, who was offering you the most value?
But value for money means very little if the scheme is standing on shaky ground financially, so the survey also considered things like:
- Age of members
- Service levels
You would think that larger schemes could negotiate lower healthcare costs with hospitals and thereby offer us – their clients – lower contributions? This wasn’t the case.
So guess who offered the best hospital plan in terms of value for money in 2017?
Genesis Private Choice.
Just so that we’re on the same page – of 23 medical schemes – including all the big guns – Genesis was rated second only to Profmed (which most of us can’t join anyway because it’s a closed scheme). That’s huge – Their score was 97.44%! Second place went to Discovery Health Essential Smart plan with a score of 92.31%. But it’s not a true comparison since the Essential Smart Plan makes use of hospitals within a network.
But where did Genesis feature when it came to issues like size of scheme, growth, solvency, average age and service levels?
Here is the ranking according to GTC:
- Discovery Health Medical Scheme – 100%
- Momentum Health – 95.65%
- Makoti Medical Scheme – 91.30% and
- Genesis Medical Scheme with a score of 86.96%.
So how can this be?
Think about it for a moment. I start a scheme with 10 people each paying R100 a month. At the end of month 1, we have R1, 000 available to pay claims. Just one huge claim and we’re sunk.
You, on the other hand, start a scheme with 50 people paying R100 a month. At the end of month 1, you have R5, 000 available to pay claims. Makes sense to say that you’ll be more successful than me, right?
And isn’t that the perception most of us have when it comes to medical schemes – the bigger the better?
But The GTC Medical Survey says different.
Genesis had a solvency ratio which has increased for each of the previous 4 years. Some of the larger schemes had a decrease in their solvency ratio over the same time-frame. How did Genesis do that with less than 10, 000 members? Apparently it has something to do with the fact that they’re self-administered. In other words, they handle all their claims and administration internally without farming it out to external service providers.
A quick word on solvency ratios:
Medical schemes are required by law to keep a solvency ratio of 25%. If their solvency ratio dips below this, how can they make it up?
- They can increase their cost next year (Which isn’t a great way to keep clients)
- They can lower their benefits offered for next year (also not ideal)
- They can hope that their claims paid this year are lower than last year (Not likely)
Why is the Genesis Private Choice option such great value?
Partly because it’s a hybrid hospital plan. Hybrid means that not only does it cover your hospital stay in any private hospital, but it also offers basic dentistry benefits. It’s also a dirt cheap hospital plan.
According to the GTC Medical Survey, the Genesis Private Choice plan fell into the ‘Hospital – all’ category. The ‘Hospital – all’ category compares hospital plans but this can be misleading since certain of the hospital plans being compared require you to make use of designated hospitals.
That’s important because the Genesis Private Choice plan allows you to use any private hospital.
- The GTC Medical Survey isn’t saying that Genesis offers the most comprehensive hospital plan on the market.
- Rather they’re saying that Genesis offers the most value for the price you pay.
- On top of that they’re saying that Genesis doesn’t have to stand back when comparing finances with some of the bigger schemes.
But wouldn’t you rather pay R200 a month more for a more comprehensive plan?
Right now in 2017, the Genesis Private Choice plan costs R1, 000 a month for a single member. Let’s assume they pay 90% of my hospital bill. Compare that to a plan which charges R1, 200 a month and covers 100% of my hospital stay.
I’d say go with the second option. But how will you know until it comes to an actual hospital stay? What if you discovered that the plan costing R1, 200 a month was providing exactly the same benefits as the Genesis Private Choice plan at R1, 000 a month?
Here is another way to look at this
- Young and healthy
- Can’t remember when last you saw a doctor, and
- Haven’t been to hospital in years
You might want to join a scheme:
- With low monthly contributions,
- Which is very solvent, and
- Which is recognised externally as offering great value for money?
Top this up with a medical gap cover policy to take care of any hospital shortfalls, and you’re A for Away. Let’s say your cost is bumped up to R1, 300 a month, BUT, your hospital cover for specialists rockets from 100% to 500% of the Genesis medical aid rate.
How comprehensive do you want to get?
Four things to consider:
- Genesis has a proven track record in the GTC Medical Survey results.
- They offer a great price,
- They allow you to use any private hospital you want to, and
- They’re rated as the best ‘value for money’ hospital plan on the market