Medical schemes have been under pressure to keep increases as low as possible, with the Registrar of Medical Aid Schemes calling for an increase of between 4,3 and 5,3% at the same time that medical inflation has peaked above 9%. "We are pleased to announce an increase which is under 10%," said Jerry van Vuuren, chairman of TopMed Medical Scheme. "TopMed's reserves are at 167,1%, way above the legal minimum reserve of 25%. Our board has wisely taken the long-term view to use the reserves to ensure our sustainability."
After listening to the requests from its members, the medical scheme will increase their medical savings to 25% on the renamed professional option (previously Incentive Comprehensive) to do away with the self-payment gap between the savings account and threshold. At the same time, in a move that will reduce pressure on members' day-to-day benefits even further, TopMed has widened the range of benefits that are paid from their risk fund.
The changes are option specific, but for TopMed professional, maternity benefit, seven days Take Out Medications (TTOs) and 75% of the TopMed Tariff for dental treatment (Conservative and Specialised) will be paid from risk. In addition, MRI and CT scans performed out of hospital now have the lowest co-payment in the industry at just R1 000.
Another major change for the professional option is the removal of the 25% co-payment on non-CDL medications that are on the TopMed Chronic Disease List (CDL). This is a list of 31 diseases, over and above the 25 specified by the registrar, which are recognised as chronic conditions by the medical scheme.
TopMed also has its sights on South Africa's future leaders. A unique new feature on the TopMed Network option, which will be particularly attractive to future professionals (and their parents), is the inclusion of full time students into the lowest cost category. This means that all primary cover will be provided for a premium of R558, regardless of whether it is the student or the parents who are paying the premium.
