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As we fast approach 200 days of lockdown, we have reached that time of the year when medical schemes announce their product enhancements and premium increases for the new year. This year the actuaries and product development teams certainly have had their work cut out for them!

At the peak of the COVID-19 Pandemic, most medical schemes would have had about 20% of their COVID-19 positive members being hospitalised, with an average of about 7 days in hospital. As an indication of cost, a patient on ventilation would incur about R250 000 in hospitalisation expenses!Whilst these “unusual” costs seem high, many elective procedures have been delayed, so whilst hospitalisation costs may end up being relatively low for 2020, delayed treatment and a possible second COVID-19 wave will “balloon” costs in the new year.

Another consideration is that CPI and tariff increases will be lower at about 3.5%, and with the Council for Medical Schemes sending out a directive that premium increases should not be more than 3.9%, many medical schemes may battle to achieve this.  Medical scheme increases have historically been between 2% & 3% above CPI. We have already seen some increases as high as 8.8%.Momentum Health recently announced an average 3.9% increase for 2021.

So, what is in store for 2021?

  • 2 new hospitals added to the Associated Network

– Bloemfontein: Mediclinic Bloemfontein

– Durban: Kingsway Hospital


  • Digital Enhancements

– WhatsApp and chat functions

– Preauthorisation Bot

– Electronic Health Record


Momentum have enhanced their Health Saver benefit, to ensure added value to members

  • New: Benefit donations – use your HealthSaver to buy Netcare Plus Vouchers (vouchers to use at Netcare providers).
  • Earn up to 10% interest on positive HealthSaver balance and pay as little as 0% interest on credit facility, based on a combination of Healthy Heart Score + Activity Levels.
  • Annual fee of R36 applies to HealthSaver with balance of more than R100.
  • Health Returns

– Added GP

– Rate booster earning benefits have been removed

– Health Returns earning potential have been

increased(lower Multiply Statuses earning more attainable)


Affordability is the main reason why medical scheme membership has remained relatively stagnant in South Africa. We have seen a number of low-cost “medical insurance” products gaining traction and to this end we are able to provide you with more detail should this be a requirement for certain employees.

We understand that some of your employees may want to consider downgrading their cover for the new year and we will be in a position to assist where necessary.

Gap cover is now well entrenched and as the various companies announce their changes for 2021 during the month of October, we will be evaluating your current cover to ensure you are optimally covered going forward.

Kind Regards,

Mark O’Flaherty

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