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So the GTC Medical Aid Survey for 2016 is out, and it makes for some exceptionally lengthy reading. Lengthy, that is, if you're an industry player; you're going to sift through it even though none of this should surprise you. Not so lengthy if, like me, you're a member of a medical aid plan or scheme and you're just going to look yours up.
Now in its sixth edition, the GTC (formally Grant Thornton Capital) surveys, analyses and presents what it considers to be the best, and the worst, of South Africa's medical aid schemes across various levels of cover. The report is written and compiled by Jillian Larkan, no stranger to the industry; she has been in the financial services sector for over 30 years and is the current Head of Healthcare Consulting at GTC. Her accolades include corporate experience at Old Mutual, Sage and Glenrand MIB, so take it for granted that you're in good hands here.
As a general introduction to the report, you should note that only 17.5 percent (according to StatsSA's General Household Survey) of South African's are currently covered by medical aid. That's 9.5 million people in 2015, up from 7.3 million in 2002. Just over 61 percent of all healthcare costs paid were for in-hospital procedures; expenditure on all health benefits paid by schemes rose to a whopping R124.1 billion.
For some, like my elderly father, a medical aid is vital; for others it tends to be a bit of a grudge purchase; because I pay both mine and my father's, I fall into the grudge category. So you can imagine that I had a look through this report to see just where the two distinct and separate plans I am responsible for are falling.
So how does the GTC determine the best and the worst? Trying to compare medical aid schemes in some sort of comprehensive way, they say, is near impossible.  Due to how the various schemes are composed, with the wide array of mixed and matched benefits, makes an apples-for-apples comparison a little out of the ballpark for even the smart folk.
No, the GTC has, instead, used cost as the main indicator, and they've done so across a wide variety of different plan categories:
·                Non-hospital (out-of-hospital benefits only);
·                Entry level (in and out, within defined networks);
·                Hospital only;
·                Saver (out-of-hospital provided by benefits or savings);
·                Comprehensive (the whole bang-shoot); and
·                Traditional (sub-limits of cover across all benefits).
Included with premium cost as an indicator is the plans' ability or likelihood to support you, the risk costs (the amount of in-hospital claims and the plan's ability to meet them) and the target market they aim for.
So based on that, here it is, for the Entry Level and Comprehensive categories: the number one ranked medical aid in the Entry Level category is CompCare NetworX, at an impressive R4 320 – R20 700 per annum, depending on the scope. You'll be forgiven if you've never heard of them. A better known plan, Bonitas BonCap, sits at number five, and Resolution's Progressive Flex plan at number 19. The Blue-Ribbon loser in this category falls to Commed Standard, with an upper ceiling of R38 040 per annum.
Now for the Comprehensive category, and here we start finding the better known players. Discovery's Essential Comprehensive plan takes third place in this category, a good result, with FedHealth's Ultimax plan taking up the bottom position at R103 120 per annum. Off the grid in a flash and taking the checkered flag is FedHealth again: this time, with their Maxima Standard option at R35 562 per annum.
They do claim that the rankings are not purely price-based, and that certain micro and macro comparisons were taken into account. While a lot of people wouldn't understand what those micro or macro considerations are, and neither would they care if they did, and considering that in this day and age price trumps pretty much everything…well, I don't think you're going to find your plan, if you're an average person like me, anywhere near the bottom of the list.
Check out the report here. I got seventh position in my category; what did you get? 


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