Profmed will be increasing its rates in 2011, but at the same time, the medical scheme for graduate professionals will be enhancing its benefits to members.
These benefits include:
Unlimited hospital cover with no co-payments or deposits: This is a valuable benefit to members as they will not have to pay anything before being admitted to hospital or in order to receive treatment and medication.
300% cover on three of the five options: This means that Profmed pays well over the stipulated fees for service providers.
New benefits for 2011 are:
Oral contraceptive benefits on all plans to the value of R100 per month.
Organ donor funding on all plans.
Increased annual overall limits for day-to-day benefits.
Profmed’s value-adds that will continue are:
Multiply Rewards Programme
International medical assistance
Preventative care benefits
Treatment and management of HIV exposure, including trauma and occupational injuries.
"Some medical aids reduce or change the benefits that are paid out of savings to keep their members’ contributions low," says Graham Anderson, Profmed’s principal officer. "Profmed does not do this. We are upfront with our members about what their contributions buy them, and will not keep contributions static at the expense of benefits."
Profmed will increase its rates slightly for a number of reasons. These are that the medical scheme anticipates that the single exit price that government sets for medication will increase by 7.5% and because of the increase in benefits, including the oral contraceptives and increased annual overall limits for day-to-day benefits, as well as the increase in hospital costs.
In spite of this, Profmed membership is still comparable to that of other medical schemes. A comparison between the contributions for a family of three for the top plans for two other medical schemes and Profmed show that Profmed is cheaper by R600 and R350 respectively, and that the proportion of the contribution that goes towards a medical savings account is around 25% - well below Profmed’s 40% Day-to-Day Benefits.
An open pharmacy network
In 2011, Profmed will be introducing a pharmacy network. The network is open to all pharmacies – individual pharmacies or chains – as long as they are willing to charge Profmed members the agreed dispensing fee of 36% to a maximum of R59,40 (excl. VAT) per dispensed item. Pharmacies are no longer allowed to mark up medication, and instead charge dispensing fees plus levies. Most medical schemes charge 26% to a maximum of R26 per item, or 36% to a maximum of R36 per item. Profmed has always reimbursed 36% to a maximum of R59.40 (excl. VAT) but some pharmacies still charge higher fees than that. "With our open pharmacy network, we are doing what we can to protect our members and ensure that they are not being charged additional levies by pharmacies," says Anderson.
Profmed also reported that in the last year, their service levels have been significantly better than ever before.
In September, on average, the processing of new members took less than two days, where the Service Level Agreement (SLA) stipulates five days. The client services call centre answered 98.7% of all calls, in comparison to the SLA’s mandated 95%, and 92% of calls are answered in under 20 seconds, which is less than the agreed 85%. Finally, claims processing took an average of one day, as opposed to the SLA of a 10-day turnaround.
"We have put a great deal of work into ensuring that we excel at customer service," says Anderson. "We are cognisant of the fact that we are working with our clients’ money at a time that they are under stress, and we know it is our duty to mitigate that stress, rather than add to it. We believe that these figures bear out our intention in this regard."
(Press release, November 2010)