Much-needed safety net introduced to cover medical scheme shortfalls

NetcarePlus have launched GapCare, a range of three gap cover products, underwritten by Hollard.

GapCare is the latest new product brought to the market in the past 18 months and follows the introduction of three other affordable healthcare products, each offering a range of options, under the NetcarePlus brand by Netcare’s Innovative Products division. 

Speaking during the GapCare intermediary launch, Teshlin Akaloo, managing director of NetcarePlus, said, “Given the current climate of uncertainty and unemployment, there has never been a greater need for new, affordable ways to access private healthcare, so that taking care of medical needs does not impact household budgets with unexpected out-of-pocket expenses.”  

The products and services introduced by NetcarePlus have been designed specifically to ensure that the provision of healthcare forms part of the funding solutions, rather than it being separate. From a Netcare perspective, we have specifically entered this space to offer certainty around quality healthcare cover and access, while also contributing to the sustainability of the private healthcare sector,” added Akaloo. 

Medical schemes market: stagnant membership and buy-downs 

According to the recently released Council for Medical Schemes annual report for 2020, medical scheme membership remained relatively stable at 8.89 million beneficiaries in 2020, down from 8.99 million in 2019. During 2020, medical scheme members paid as much as R32.8 billion towards out-of-pocket medical bills even though overall medical expenses decreased because of the pandemic. At the same time, the portion paid from medical savings accounts increased to an all-time high of R18.2 billion. 

“The trend in medical scheme buy-downs, which started emerging in recent years, has increased considerably, with more members opting for more affordable plans. This has resulted in the increased popularity of gap cover. 

The more affordable medical scheme options are also typically characterised by the use of a selected network of hospitals and providers, which ultimately limits the choice that a scheme member has. 

“Gap cover has been an essential component of health and financial planning for more than a decade, with medical scheme members and healthcare intermediaries increasingly valuing its role as an add-on to most medical scheme products. More recently it has become quite clear that it is a product of vital importance. In fact, healthcare consultants are increasingly recommending that medical scheme products are sold along with gap cover to give members more certainty around being able to fund additional payments that may result from their healthcare needs,” comments Akaloo. 

NetcarePlus GapCare – what’s on offer? 

GapCare, GapCare 300+ and GapCare 500+, the new NetcarePlus range of insurance products, will provide cover for the shortfall in medical expenses to medical scheme members. The cover provided ranges from in-hospital specialist cover, oncology benefits, emergency department costs for emergency medical conditions, as well as co-payments for the voluntary use of non-network hospitals amongst others. 

What differentiates the NetcarePlus GapCare is the cover provided for emergency department costs beyond accidents, shortfalls for out-of-hospital specialists and an extension of day-to-day costs when medical scheme savings have run out or limits are reached. It also offers cover for high-risk pregnancies and other maternity-related benefits. Upfront co-payments for using any Netcare hospital that is not part of the member’s medical scheme network will be fully covered and does not have to be paid by the member and claimed thereafter, as is the case with traditional gap cover. 

“We are acutely aware of the administrative burden in the gap insurance industry and have thus placed particular emphasis on eliminating upfront payments by members as far as possible,” adds Akaloo. 

Joining forces with Hollard  

Commenting on the introduction of GapCare, Besa Ruele, chief executive officer of Hollard Life Solutions, said that the partnership between Hollard and NetcarePlus continued to deliver synergies that were making financial inclusion and access to quality healthcare a reality for many South Africans. 

“We are pleased to be a part of this innovative answer to reducing the medical funding challenges many South Africans grapple with. NetcarePlus products offer a practical mechanism providing reassurance that access to private healthcare is secured in advance – before it is needed. The outbreak of the COVID-19 pandemic has brought into sharp focus the fact that access to quality healthcare is becoming increasingly important for all of us. As a company at the forefront of developing solutions that mitigate against life’s unexpected eventualities, we are acutely conscious of the importance of preparing for the challenges that life throws our way,” added Ruele. 

Snapshot of NetcarePlus service offering 

In the past year NetcarePlus, which was established early in 2020 at the start of the COVID-19 pandemic, has reached several important milestones, including the introduction of the range of NetcarePlus GP vouchers, the launch of its first prepaid surgical procedure for cataract removal, and the introduction of its first insurance product, NetcarePlus Accident and Trauma Cover. A further three prepaid procedures, including pterygium removal, vasectomy and circumcision were also introduced and more recently NetcarePlus launched eye care vouchers, with dentistry vouchers due to follow before the end of 2021. 

“The latest offerings from NetcarePlus complements and expands our existing healthcare services and has enormous potential to make it possible for many more South Africans to benefit from private healthcare services” says Akaloo. 

“By making private healthcare more accessible, we are able to deliver certainty and peace of mind to consumers during these uncertain times. Quality healthcare helps people live to their full potential. With our full range of products, we hope to substantially enhance healthcare access so that many more South Africans can affordably take care of their health through the extended Netcare ecosystem,” Akaloo concludes. 

Note: The NetcarePlus GapCare product is underwritten by The Hollard Insurance Company Limited (Hollard), a licensed non-life insurer and an authorised financial services provider. This cover is not a medical scheme, and the cover is not the same as that of a medical scheme. This insurance product is not a substitute for medical scheme membership.