2024 benefits and contributions

Factors determining benefit and contribution changes

In the assessment of the annual contribution and benefit changes, numerous factors are taken into consideration. The objective is to balance the Scheme's long-term sustainability against making funds available for benefits that will amply cover our members' healthcare needs while keeping contributions affordable. As members age and require more medical treatment, technology and medicine continue to advance and healthcare professionals become scarcer, the costs of claims increase. Our actuaries analyse these risk factors, along with the financial and demographic trends, and determine the expected level of reserving required to fund future claims. In consideration of our members' needs, the Trustees then make changes to the benefits and utilise funds from the reserves to ensure that the contribution increases remain acceptable, but within the actuarially determined reserving level.

Better benefits for lower contributions

To ensure that we offer benefits as good or better than the industry average, our Trustees constantly monitor market and industry trends and benchmark our plans against those of other schemes. Comparing benefits across the industry is a complex task as no two plans offer the same benefits or have the same network arrangements, medical savings account structures or limitations.

In 2023, both our independent consulting actuaries and the Scheme's administration actuaries conducted a comprehensive benchmarking exercise. The outcome of this exercise showed that all AMS plans ranked among the top 3 in their respective categories. Notably, both actuarial reports reaffirmed AMS's competitive pricing, with contribution rates significantly lower than those of comparable options. Furthermore, our plans offer more generous benefits, providing more value for every rand spent.

Given our Scheme's robust standing, the Trustees agreed to maintain contribution increases at the lower end of the market expectation, and to improve benefits to a total projected value of +/- R600 million for 2024.

Benefit improvements for 2024

Benefit limits and Scheme Reimbursement Rates were, on average, increased by 5.5% across all plans.

We are pleased to announce, that from 2024, Value Care Plan members will have access to unlimited virtual GP consultations at Dis-Chem clinics when clinically appropriate. The dental benefit has also been improved, allowing families to obtain two sets of dentures every three years and denture repairs six months after issue. Additionally, the contribution increase has been kept 1% lower than the increase on the other two Plans.

Good news for Standard Care Plan members: the already comprehensive dental benefit, as confirmed by the Dental Risk Company, our administrator and the benchmarking exercise has been further enriched with the addition of one panoramic radiograph per beneficiary every three years. The Additional Basic and Specialised Dentistry Benefit limit was increased by 17.2%, and not by the overall increase of 5.5%. Members diagnosed withMyasthenia Gravis will receive funding for their medication from the non-PMB Chronic Medicine Benefit in 2024.

Managed Care Plan members will benefit from a 14.9% increase in the conservative and advanced dentistry limit, paid by the Scheme, not from their Medical Savings Account (MSA). Moreover, a new basic optometry benefit funded by the Scheme has been introduced, over and above their MSA availability. With these two benefit improvements, members will be able to use their MSA to fund other benefit categories.

After considering member, employer and Scheme funding requirements, the average 2024 AMS contribution increase was agreed at 6.9%, at the lower end of the market as seen below.

Top 7 open scheme average contribution increases as available at the time of publishing

2024 contributions

The 2024 benefit and contribution changes are, as always, subject to the approval of the Council for Medical Schemes.

Last call to participate in our year-end presentations:

Learn more about the 2024 benefit and contribution changes by attending our year-end presentations. RSVP to your CLO today to attend our virtual or physical year-end presentations.

Published October 2023