HR Professionals must know what employee benefits to look for.

While South Africa seems to be keeping a looming recession at bay for now, a sentiment of caution among employers has resulted in a general tightening of belts – a prudent move, no doubt. When it comes to assessing employee healthcare needs against a significantly restricted budget, there are several important questions to ask.

How to know where to start

Everyone has different requirements and unfortunately, there is no silver bullet for this complex area of your staff benefits. However, a good baseline to start from is a medical scheme option that will cover in-hospital procedures and pay no less than standard medical scheme tariffs.

If opting for a hospital plan or savings plan – which can effectively reduce costs without cutting essential healthcare expenditure altogether – be aware of any limitations. Some options may, for example, require you to make use of particular healthcare facilities or healthcare providers within a preferred network, which is a valuable cost saving initiative where pre-agreed rates have been arranged with facilities and healthcare providers to obtain the best possible value for scheme members.

If you are keeping it simple by choosing within this range of products, opt for a hospital plan that provides unlimited cover at any private hospital for greater flexibility, a comprehensive cancer benefit for real peace of mind, and, of course, cover for the 27 chronic conditions that form part of the minimum benefits every scheme must cover, to ensure that your people have the right mix of essential healthcare benefits to fall back on.

Key areas of concern when choosing an employee medical scheme

Firstly, we have to say it – cost. This is increasingly becoming a key consideration and for good reason. After all, you cannot overlook the importance of the financial health of your business. At the same time, you need to ensure that your medical coverage adequately meets your employees’ needs so that you are not at risk of being caught short.

It is therefore a matter of striking the right balance for your staff needs specifically, which will largely depend on factors such as age and the general stage of life of your employee base. This brings us to the second key consideration. If you have several young employees who are in good health, it might not be advisable to allocate budget to a really comprehensive option with benefits that they are unlikely to use.

For those with young families, a value for money savings option would be a good choice, particularly if it provides a special children’s range of benefits covering everything from baby wellness visits to childhood immunisations, school readiness assessments, pre-school eye and hearing tests and a dental screening.

Look for options that include meaningful benefits for parents, such as an extra visit to an emergency room every year – a benefit they will certainly thank you for. Furthermore, if you can find an option that includes a consultation with an occupational therapist, a fitness assessment and exercise prescription programme, as well as a nutritional assessment and healthy eating plan that is offered especially for children, all the better.

And, for children younger than six, aim for unlimited GP visits and basic dentistry even if benefits are depleted. This kind of family-oriented option that pays such wellness benefits from the scheme’s risk pool must also consider the importance of excellent men’s and women’s health benefits.

On the other hand, if you have executives on your books who seem to be in peak health and are mentally still in their 30s but are turning 60-something this year, it’s time to look at an option that will ensure you have the added safety net of above-threshold benefits in case they or their family have any unforeseen medical, specialist and dental expenses, as well as really comprehensive cover for 65 chronic conditions.

And it should go without saying, but never underestimate the importance of doing thorough research. All the sales talk in the world cannot make up for the value of hard fact when it comes to the reliability of a medical scheme, so make sure you are placing your trust in a scheme you and your people can count on.

For example, you want an experienced medical scheme with a proven track record of at least several decades in the business of healthcare. That being said, it is the personal interaction and the care a scheme provides that can make a real and lasting difference to the members whose lives it touches every day. You will naturally also want a scheme that is financially secure with a solvency ratio well in excess of the minimum 25% required by the Council for Medical Schemes.

This can be a complex process, and working with a reputable financial advisor may well be the wisest move, as they will be able to shed some light on the ins and outs of differing benefit options while also bringing valuable industry insight to the table.

Initiatives to decrease and maintain healthcare costs

Rising healthcare costs are given as one of the reasons for above inflationary increases in medical aid cover. While it is true that healthcare inflation is an ongoing challenge, there are schemes that had the foresight to forge ahead with innovative cost-saving initiatives some time ago – initiatives which have not only proven to be highly effective in meeting member needs but are ensuring that healthcare remains accessible and affordable.

Efficiency discounts, for example, allow for reductions of up to 25% of the normal contribution rate on certain options for members using designated pharmacies and hospitals. For savvy consumers, these discounts translate into considerable savings and are particularly well received by companies which are looking to add value to the financial packages offered to staff members across the board.

And, my advice would be not to stop there. Seek out other value-adding innovations that are paid from a scheme’s risk pool, such as a prescription exercise benefit and nutritional benefit. These special features can provide your staff with the opportunity to regularly consult accredited biokineticists and dieticians. Such structured programmes, if provided under the guidance of nutrition and exercise professionals, can enhance the health and wellness of your team.

The health of teams across all industries would be significantly better if greater emphasis were to be placed on primary health and preventative care through an individualised approach.

The ‘cherry on the top’

While it may not be a topic often discussed, many of your employees may still be providing financial support in one form or another to their young adult children who are studying or just starting out in the working world. Look for a scheme that offers child rates beyond the normal age of 21, for example, up to the age of 27. In the times we live in, this is a phenomenal benefit, the value of which should not be underestimated.

A scheme that has leveraged technology by introducing online consultations across all benefit options via a secure and user friendly platform will also win the hearts and minds of those seeking the convenience of digital healthcare access.

By partnering with a medical scheme that provides your employees with confidential online consultations with their GP, therapist and other healthcare providers, as well as being able to receive encrypted electronic healthcare documents, you are saving your people – and possibly your business – time and money.

Finally, an emotional wellness benefit available free of charge on all options of a medical scheme demonstrates true care for the overall wellbeing of members, with access to a 24-hour helpline with trained clinical professionals and referrals for face-to-face counselling when required.

It may seem like a daunting task to find the best possible medical scheme for your people, given the number of options out there, but there are factors that can help you identify the best fruit in basket – you just need to know what to look for

Josua Joubert is Chief Executive and Principal Officer at CompCare Medical Scheme.