Discovery and their insane price increase

SauRoNZA said:
Only until the doctor on standby that night is a 300% doctor then you still end up paying for it.

Hence the gap cover.
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Hope that standby doc had to see the patient for a PMB condition so that the medical aid can cover it. Else, yeah.
 
NR7 said:
CPI plus 4% is such sugarcoating from Discovery, just say the truth that it's more than double inflation on some of their plans.
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CPI itself is basically made up shenanigans ANYWAY. They constantly move things from bucket to bucket to keep CPI around 3 or 4% when on the ground it costs like 10% more per year to keep the same standard of living.

Electricity keeps climbing, food prices, petrol, everything. Every company/service you use goes up yearly by far more than 3 or 4% yet somehow "inflation has been pretty stable at 3 point whatever %".
 
NR7 said:
Which companies actually offer good gap cover?
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I've been with Elixi since 2015 and they've been ok. Their fees seem competitive. Has doubled in that time.
 
bwana said:
My kid was recently involved in a car accident out of town a couple of weeks back. A week in hospital and a few surgeries later cost in excess of R350000 which Discovery has picked up. We're scrapping over a few items but if they don't cover those Gap will.

I'm not suggesting the premiums aren't high, even on our budget Essential Delta Core plan, but it's worth having when you need it.


Your solution costs more than theirs.
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oh shame man the kid ok ?
 
NR7 said:
Which companies actually offer good gap cover?
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If you're with Momentum and have Gap cover through them (Guard Risk), you don't need to do anything. Once your medical aid has completed their side of the claim, it is automatically sent through to GAP for further processing.

I'm "busy" with 2 claims right now so I know this to be true as 2 emails arrived this morning from Momentum GapCover to say they're processing the shortfall claims.

Ease of use: 5 Stars
Will they pay all of the shortfalls: TBA.

Out of interest:
Momentum Health was modelled off Discovery more than 2 decades ago.
I was one of their first 4000 or was it 6000 (can't recall now) customers to join when they still called themselves Pulz. Other than the cost of "owning" a medical aid (Tax Deductible), I've been moderately pleased over the years.
Pulz was a medical aid plan launched by Momentum in July 2003 as a joint initiative with Sovereign Health.

📉 History and Evolution
    • 2003 Launch: Introduced by Momentum to market its own medical scheme instead of promoting Discovery Health.
    • 2004 Growth: Reached over 6 000 members in its first year of operation.
    • 2005 Merger: Amalgamated with the National Medical Plan (NMP) to form what is now known as Momentum Medical Scheme.
 
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BTTB said:
If you're with Momentum and have Gap cover through them (Guard Risk), you don't need to do anything. Once your medical aid has completed their side of the claim, it is automatically sent through to GAP for further processing.

I'm busy with 2 claims right now so I know this to be true. Two emails arrived this morning from Momentum GapCover to say they're processing the 2 shortfall claims.

Ease of use: 5 Stars
Will they pay all of the shortfalls: TBA.

Out of interest:
Momentum Health was modelled off Discovery more than 2 decades ago.
I was one of their first 4000 or was it 6000 (can't recall now) customers to join when they still called themselves Pulz. Other than the cost of "owning" a medical aid (Tax Deductible), I've been moderately pleased over the years.
Pulz was a medical aid plan launched by Momentum in July 2003 as a joint initiative with Sovereign Health.

📉 History and Evolution
    • 2003 Launch: Introduced by Momentum to market its own medical scheme instead of promoting Discovery Health.
    • 2004 Growth: Reached over 6 000 members in its first year of operation.
    • 2005 Merger: Amalgamated with the National Medical Plan (NMP) to form what is now known as Momentum Medical Scheme.
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I remember those Pulz guys... everyone laughed and said it was hot garbage... look at this now....
I've been fukked hard by Disrobbery... I can't afford them even if I tried.
 
Pretty sad to see the cost of medical coverage in South Africa shoot up, while the quality of care and product offerings get more complicated and shittier. From my understanding, this is only possible because the private healthcare market in ZAF operates in a mostly unregulated space. There are no guardrails in place to prevent some bad behaviours from medical insurance companies - other countries that operate private healthcare markets have installed legal guardrails against some common bad behaviours. Costs will continue rising while the quality of care remains flat or worsens. I see South African medical aid companies (including Discovery) do some of these bad behaviours and its always sad knowing that I read about other countries that outlawed such practises.

I am pretty sure I read in one of the CompCom's reports that in the years that followed COVID-19, many medical aid companies had cash surpluses and did not pass on the savings to the consumer. I am pretty sure I read that somewhere.
 
koeks525 said:
Pretty sad to see the cost of medical coverage in South Africa shoot up, while the quality of care and product offerings get more complicated and shittier. From my understanding, this is only possible because the private healthcare market in ZAF operates in a mostly unregulated space. There are no guardrails in place to prevent some bad behaviours from medical insurance companies - other countries that operate private healthcare markets have installed legal guardrails against some common bad behaviours. Costs will continue rising while the quality of care remains flat or worsens. I see South African medical aid companies (including Discovery) do some of these bad behaviours and its always sad knowing that I read about other countries that outlawed such practises.

I am pretty sure I read in one of the CompCom's reports that in the years that followed COVID-19, many medical aid companies had cash surpluses and did not pass on the savings to the consumer. I am pretty sure I read that somewhere.
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Go to the USA, you ain't seen nothing yet. SA is largely a copycat of what goes on there... it's even worse in the land of the free.
 
Medical costs are going up world wide. Led by the USA pharmaceutical companies are aiming for super profits. A drug that keeps my daughter alive right now gets manufactured for about 30K for a years treatment, but they charge about 170K a month for it. That is a recent price drop. Prior to a big court case that a CT lady ran against the pharm company it was half a million a month so no one could be on it other than the hyper rich EU/Canadian state health plans. They paid off their research costs so many times over but with 25 year patents on medicines they know they have a captured and desperate market and they will milk it for all they are worth.

The other factor is the whole world is in a cost of living crisis right now and as a result more and more people are dropping medical aid, especially if they are healthy. Medical aid is cheap when it has lots of healthy people on it subsidizing the unlucky sick people. It is also not terrible for the healthy as believe me, life can change in an instant and if you try join the medical aid after the diagnosis of something long term and expensive it will be excluded. People need that insurance but just can't pay it anymore. It can become a death spiral. The more prices go up, the more people leave with the healthy leaving first, the desperate and sick have no choice but to stay or die but the price increases make them pay more and more. Cycle continues until no one can afford it and it collapses.
 
Cius said:
Medical costs are going up world wide. Led by the USA pharmaceutical companies are aiming for super profits. A drug that keeps my daughter alive right now gets manufactured for about 30K for a years treatment, but they charge about 170K a month for it. That is a recent price drop. Prior to a big court case that a CT lady ran against the pharm company it was half a million a month so no one could be on it other than the hyper rich EU/Canadian state health plans. They paid off their research costs so many times over but with 25 year patents on medicines they know they have a captured and desperate market and they will milk it for all they are worth.

The other factor is the whole world is in a cost of living crisis right now and as a result more and more people are dropping medical aid, especially if they are healthy. Medical aid is cheap when it has lots of healthy people on it subsidizing the unlucky sick people. It is also not terrible for the healthy as believe me, life can change in an instant and if you try join the medical aid after the diagnosis of something long term and expensive it will be excluded. People need that insurance but just can't pay it anymore. It can become a death spiral. The more prices go up, the more people leave with the healthy leaving first, the desperate and sick have no choice but to stay or die but the price increases make them pay more and more. Cycle continues until no one can afford it and it collapses.
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And Adrian will then just move on to the US or some other country where he can rake it in and get a new Ferrari every year.
Maybe Italy is more to his liking...
 
EmmanuelGoldstein said:
And Adrian will then just move on to the US or some other country where he can rake it in and get a new Ferrari every year.
Maybe Italy is more to his liking...
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Adrian is not a big concern for me. SA law means the medical aids cannot make direct profit. The administrators of the fund can take a fee per claim processed but that is fairly competitive. If your provider gets expensive you can switch to a more efficient administrator like Bonitas did (not sure it entirely worked out for them). New provider dropped the ball there.

What that means is if you need a cancer drug to live, and the scheme denies treatment. The money saved cannot in any way flow into the companies profits. It just means the funds are still available for other members needs. This is very different to the USA. There if they can kill off particularly expensive members via denying them treatment it does in fact make them directly more profitable. They keep the funds they collect that do not pay out. Life insurance works that way in SA but not medical aid. Funds for treatment are ringfenced and kept separate. The law also stipulates certain conditions that have to be covered. The PMB conditions. SA has one of the best balances I feel in the world for private medical aid. What is breaking it for us is what I said above. Rising base costs for medicines and treatments, and a real drop in affordability that is being driven by the current global cost of living crisis. The real cost of living is going up by far higher than inflation and salaries globally. It is putting a lot of pressure on all medical schemes globally.
 
Losing members because their price increase is insane, also doesn't seem to bother them, does it?
 
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