2018 benefit improvements and contribution increases

The AMS Board of Trustees remains committed to improving the value of your medical scheme benefits. For your contribution spend, AMS members still get more generous benefits than most other medical schemes can offer. The challenge is how to stretch your rand further.

Schemes generally put measures in place to manage health care costs in the interest of all members. Every year AMS evaluates existing cost containment measures and considers alternative and new initiatives that might be suitable to stretch your contribution further. The aim is always to provide benefits for the best care possible while keeping the contributions as low as possible.

The following changes will be introduced in 2018:

A dental network on the Standard Care Plan (SCP)
79% of our SCP members spend their dental benefit on basic dentistry. The Scheme has contracted the Dental Risk Company (DRC), to provide a range of basic dental services at an agreed network rate. Members visiting a network provider, will not have to pay upfront or experience co-payments when receiving these services. 75% of our SCP members already visit these network dentists and 95% of our members will have access to a network dentist within 5km of their homes. If you choose to continue to use a dentist outside of the network, you will have to pay a co-payment (the difference between 80% of Scheme Reimbursement Rate and the claimed amount).

If the range of basic dental services is insufficient, a limited extended dental benefit can be used for additional basic or specialised dentistry.

Introducing a network for orthotists and prosthetists
From 2018, AMS will participate in Discovery Health’s network of orthotists and prosthetists, offering favourable rates for AMS members.

20% co-payment for use of non-DSP ambulance
Netcare 911 is the Scheme’s Designated Service Provider (DSP) for emergency ambulance services and evacuation. In 2017 AMS’ ambulance claims were 40% higher than the capitated fee the Scheme pays to Netcare 911. In an effort to manage excessive costs, the voluntary use of a non-DSP (if you call another ambulance provider voluntarily) will result in a 20% co-payment from 2018. Please always remember to call 082 911 if you need an ambulance or emergency evacuation. Better still, save this number in your phone under A for AMS Ambulance!

HIV/AIDS Disease Management now managed by the Scheme’s dedicated team
From 2018, HIV/AIDS Disease Management, previously carried out by One Health, will be managed by the Scheme’s dedicated HIV/AIDS management team. The way the Scheme manages this disease will not change; members will receive the same benefits and services as before, medicine will continue to be supplied by Dis-Chem Direct and the confidential treatment of this disease will of course remain. This decision was taken by the Board in the best interests of our members and the Scheme. Members currently registered on this programme will receive personalised and more detailed information about this change.

‘GAP’ replaced by ‘Top-Up rate’
Lastly, those of you who participated in the Scheme’s recent survey will be aware of the potential, and in some instances, real confusion between our higher reimbursement rate on the Managed Care Plan (MCP) and gap insurance products now available in the market. We have changed the name of our ‘GAP rate’ on MCP in our Benefit Guide to ‘Top-Up rate’. This is only a cosmetic change, 230% of the Scheme Reimbursement Rate is still applicable, only the name has changed.

For more information, please refer to your 2018 Benefit Guide, which we will post to you at the beginning of November. An electronic version will be available on the Scheme website, as usual.

Contributions will increase by 8.9% on average
In difficult and stressful times members tend to get sicker, needing more scheme benefits. Doctors and specialists are in short supply, work longer hours and are able to charge more, while financial markets generally deliver lower returns. This all adds up to higher inflation for medical costs than the published CPI. It is anticipated that the 2018 scheme increases across the industry will be close to double digits. AMS has done what it can to keep the contributions affordable and as low as possible. The 2018 rates are shown below:

Contributions per plan

2018 benefits and contributions subject to the approval from the Council for Medical Schemes

Deadline for plan changes: 31 December
PLAN CHANGES: If your health care needs or income have changed and you are considering changing plans for the coming year, you may do so at the end of the year. We urge you to speak to one of our Client Liaison Officers (CLOs) or your Paypoint Consultant for advice. Your plan change form is included in the back of the Benefit Guide (also available on the Scheme website) and must be handed to your employer or past employer before 31 December. Direct-paying members must submit their forms directly to the Scheme.

<< back to all news