Alex Forbes Diagnose 2014

8/10/2019 Alex Forbes Diagnose 2014

1/36

An analysis of key trends in the medical schemesindustry (20002013)

DIAGNOSIS2014/2015

Alexander Forbes Health Technical and Actuarial Consulting Solutions

HEALTH


2/36

Introduction

Our Technical and Actuarial

Consulting Solutions (TACS) team is

proud to present this publication in

collaboration with our Research &

Product Development department and

we are confident that the content willgive you a comprehensive overview

of the financial and demographic

performance of medical schemes since

2000 as well as some of the challenges

currently faced by the industry.

This analysis covers key statistics

and trends over the 14-year period

from 2000 to 2013, based largely

on the consolidated financial results

for all registered medical schemes,

with specific focus on the ten largestopen and the ten largest restricted

membership schemes.

We believe this publication will serve

as a useful reference to trustees,

employers and industry commentators

by giving insight into the demographic

and financial trends of the industry.

If you would like to discuss any of

the issues addressed in more detail,

please speak to your Alexander ForbesHealth consultant or contact one of the

technical specialists listed at the end

of this publication.

Welcome to the latest issue of Alexander Forbes Healths Diagnosis,an analysis of key trends in the medical schemes industry.

2

ALEXANDER FORBES HEALTH


3/36

Contents

1. Key industry developments 4

2. Performance indicators 6

2.1 Size and scale 6

2.2 Market share 11

2.3 Membership profile 12

2.4 Contributions 162.5 Inflationary trends 17

2.6 Healthcare (claims) expenditure 19

2.7 Non-healthcare expenditure 21

2.8 Financial performance 23

2.9 Investments 26

2.10 Solvency levels 28

3. Medical Schemes Sustainability Index 30

4. Conclusion 34

5. Alexander Forbes Health 35

3

DIAGNOSIS 2014/2015


4/36

1. Key industry developments

1998 The Medical Schemes Act

(131 of 1998) is signed into law.

It introduces prescribed minimum

benefits (PMBs), community-ratedcontributions and open enrolment.

2000 The Medical Schemes Act

comes into effect and the

Council for Medical Schemes

(CMS) is established.

2003 The National Health Act(61 of

2003) gives a framework for a

structured and uniform health

system for the entire country. Personal medical savings

accounts are limited to 25%

of gross contributions.

2004 A Competition Commissionruling

bans the system of collective tariff

setting between schemes and

healthcare providers. Single exit price(SEP) is

implemented for pharmaceutical

manufacturers.National Health Reference PriceList (NHRPL) is first published by

the Department of Health. Medical schemes must maintain a

minimum solvency level of 25%.

2005 The Government Employees

Medical Scheme(GEMS)

is registered. The Childrens Act(38 of

2005) stipulates the age of

consent of minors to medical

and surgical treatment.

2006 The CMS takes over publication

of the National Health Reference

Price List(NHRPL), a guideline

for healthcare service tariffs.

The main developments in the medical schemes industry since the

promulgation of the Medical Schemes Act (131 of 1998) are:

4



5/36

2013 The Financial Services Laws

General Amendment Act

(45 of 2013) amends the

Medical Schemes Act by wideningthe definition of the business of a

medical scheme. Schemes must hold members

medical savings account (MSA)

contributionsseparate from

scheme reserves and allow

interest to accrue to positive

MSA balances. The National Health Amendment

Act(12 of 2013) provides for

the establishment of the Office

of Health Standards Compliance

(OHSC), a key building block

of NHI.

The Competition CommissionInquiry into Private Healthcare

is announced. The Protection of Personal

Information Act(4 of 2013)

(POPI) is signed into law.

2014 The 12-member board of the newly established Office of Health

Standards Compliance(OHSC) is named. Second Draft Demarcation Regulationsinclude an allowance for gap

cover products and hospital cash plans under strict conditions. The Competition Commission Inquiry into Private Healthcarestarts. A

final report is due by the end of November 2015.

The Draft Road Accident Fund Benefit Billprovides for a no-fault benefitscheme and a new Administrator to replace the Road Accident Fund. The Financial Services Board (FSB) introduces Treating Customers

Fairly(TCF), a market conduct framework of regulatory reform. The National Department of Health publishes a National Health

Insurance (NHI) booklet.

2011 The Consumer Protection Act

(68 of 2008) comes into effect tosupport and strengthen a

culture of consumer rights

and responsibilities. The Green Paper on the National

Health Insurance Policyis

published for public comment.

2008 The Medical Schemes Amendment Billis proposed but not

signed into law. It provides for the Risk Equalisation Fund

(REF), low-income benefit options, improved governance,and an amendment of the definition of the business of a

medical scheme. The Health Professions Council of South Africa (HPCSA)

scraps ethical tariffs, used by providers as a ceiling for

patient accounts.

2009 The Competition Amendment Act(1 of 2009) is signed into law. It provides a legal framework

and gives formal powers to the Competition Commission to conduct market enquiries. The Protection of Personal Information (POPI) Billis published to provide for the protection

of personal information processed by public and private bodies, including medical schemes

and other relevant industry stakeholders.

2012 The Taxation Laws Amendment Act(22 of 2012) provides for a new medical tax

creditsystem to replace medical deductions. The definition of a dependantis

widened in the Income Tax Act to be the same as the definition of a dependant in

the Medical Schemes Act. Draft Demarcation Regulationspropose the removal of most gap cover products and

hospital cash plans.

2010 Dispensing fee regulationis

introduced for pharmacists and

licensed health professionals. The High Court rules the NHRPL

invalidand sets it aside. The Board of Healthcare Funders

(BHF) court application to

seek clarity on the meaning of

Regulation 8(1)is dismissed by

the High Court. The CMS publishes the PMB

Code of Conductto ensure

compliance with Regulation 8(1)

pay in full.

5

DIAGNOSIS 2014/2015


6/36

2. Performance indicators

This section analyses some of the key statistics influencing theperformance of medical schemes.

When evaluating the performance of medical schemes, some of the key factors to consider are:

2.1 Size and scale

Medical schemes in numbers

Size and scale

Membership growth and risk profile

Financial results and solvency levels.

Beneficiaries in open medical schemes Beneficiaries in restricted medical schemes

Number of open medical schemesNumber of restricted medical schemes

0

10

20

30

40

50

60

70

80

90

100

0

1 000 000

2 000 000

3 000 000

4 000 000

5 000 000

6 000 000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Numberofmedicalschemes

Numbe

rofbeneficiaries

Year

6



7/36

In 2013, the number of medical

schemes continued to decline. At

the end of 2013, there were 87

registered medical schemes in South

Africa, a decrease from 97 in 2011

and 92 in 2012. During 2013,

four restricted membership medical

schemes amalgamated into the

open medical scheme market. These

included IBM SA Medical Scheme and

Nampak SA Medical Scheme, which

both amalgamated with Discovery

Health Medical Scheme, and Sappi

Medical Aid and Minemed Medical

Scheme, which both amalgamated

with Bestmed Medical Scheme.

There was one open medical schemeamalgamation, with ProSano Medical

Scheme amalgamating with Bonitas

Medical Fund. While there were

three liquidations during 2012, none

occurred in 2013.

The downward trend in the number

of medical schemes from 144 at

the end of 2000 to 87 at the end of

2013, representing a 40% decrease

in the number of registered medical

schemes in 13 years, is the result

of continued amalgamations and

liquidations (voluntary and involuntary)

across the industry. The number of

open medical schemes has decreased

by 23 (49%) compared to a decrease

of 34 (35%) restricted medical

schemes over this period. Our view

is that this consolidation is driven

partly by the difficulty in maintaining

the sustainability of small schemes

in the current environment and for

restricted schemes in particular, by

the significant amount of management

time needed to manage an employer-

based restricted scheme.

This consolidation in the industry

has continued into 2014 with the

following schemes amalgamatingduring the year:

Discovery Health Medical Scheme

and Altron Medical Aid Scheme

(1 January 2014) Topmed Medical Scheme and Pharos

Medical Plan (1 January 2014) Discovery Health Medical Scheme

and Afrox Medical Aid Society

(1 May 2014) Discovery Health Medical Scheme

and PG Bison Medical Aid Society

(1 May 2014).

Despite the continued decrease in

the number of medical schemes,

the industry has still grown by

1.3 million (49%) principal members

and 2 million (30%) beneficiaries

since 2000. The 87 medical schemes

operating in South Africa at the end

of 2013 served a total of 3.9 million

principal members and 8.8 million

beneficiaries, a growth of 1.6% and

1.1% respectively from 2012.

A total of 58.2% of principal members

participated in open medical schemes

at the end of 2013 with the balance

of 41.8% participating in restricted

medical schemes. This compares to57.6% and 42.4% respectively at the

end of 2012. This is the first time

that the market share of open medical

schemes has increased since 2005, as

membership growth on the Government

Employees Medical Scheme (GEMS)

has served to decrease the market

share of open schemes since its

registration in 2006.

The graph on the following page shows

the percentage annual growth in

medical scheme membership over

the last 13 years.

Despite the continued decrease in the

number of medical schemes, the number

of covered lives has still grown.

7

DIAGNOSIS 2014/2015


8/36

Annual percentage growth in membership

-5%

0%

5%

10%

15%

20%

25%

30%

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Percentageannualgrowthrate

Open schemes Restricted schemesAll schemes

Year

There is a stark contrast in the trends

in the annual growth rate of open and

restricted medical schemes, with the

most notable difference observed in

2006 with the registration of GEMS.

Since 2006, the growth rate in open

medical schemes has fluctuated

between 0% and 3% per year. While

the rate of growth in the restricted

scheme environment has exceeded 5%

for most years since 2006, this growthhas slowed considerably to 0.3% from

2012 to 2013.

The minimum membership requirement

set by the Council for Medical Schemes

(CMS) for registering a new medical

scheme is 6 000 principal members.

At the end of 2013, there were

two open medical schemes and 29

restricted schemes with fewer than

6 000 principal members. The open

schemes with membership below this

threshold were Medimed Medical

Scheme (5 446 principal members)

and Makoti Medical Scheme

(2 633 principal members).

A small membership base generally

results in a more variable claims

experience, which increases the

risk of contributions not being set

at an appropriate level to cover all

claims and expenses. This variability

is compounded further by thenegative impact of high cost claims,

especially in the current environment

where schemes are required to pay

in full for the cost of prescribed

minimum benefits, regardless of

the rates charged. Some of this risk

can be mitigated where schemes

are administered by one of the

larger administrators and can rely

on their administrator to negotiate

reimbursement rates with healthcare

service providers on their behalf.

Despite the risks

involved in small

medical schemes and

the fact that many are

amalgamating, there

are still a fair number of

small schemes that are

performing well. Of the31 schemes with fewer

than 6 000 members,

13 achieved a surplus

before investment

income in both 2012

and 2013, which

indicates a combination

of a good profile as a

well as sound financial

and risk management.

8



9/36

The graph below ranks the top 10

open schemes and top 10 restricted

schemes in terms of the number of

principal members as at 31 December

2013. This represents 85.5% of all

principal members participating in

registered medical schemes, or 92.4%

and 75.8% of principal members

participating in open and restricted

medical schemes respectively.

While we have continued to include

the largest ten open medical schemes,

this year we have also included the

largest ten restricted medical schemes,

rather than just the largest five, in

order to provide relevant analysis to a

broader audience. In addition, many

of these schemes could be deemed to

be competitors of some open schemes.

As an example, members eligible to

join Profmed could also be eligible to

join any of the open schemes. Other

schemes such as LA Health Medical

Scheme (LA-Health) and SAMWUMED

would be relevant to employees of local

government who would also be able

to join specified open schemes. As a

result, some employers or individual

members would compare these open

and restricted schemes together when

making decisions relating to medical

scheme cover.

The ranking by size of the top 10 open

medical schemes has remained largely

unchanged since 2012. As a result of

two amalgamations, Bestmed Medical

Scheme moved up two places to

number 5, moving Medshield Medical

Scheme (Medshield) and Fedhealth

Medical Scheme (Fedhealth) down

one position each to positions 6 and 7

respectively. Liberty Medical Scheme

(Liberty) and Sizwe Medical Fund(Sizwe) switched between positions

8 and 9 and KeyHealth re-entered

the top 10 in 2013, with 36 019

members, replacing Resolution Health

Medical Scheme (Resolution) from

2012. Resolution is now the 11th

largest open medical scheme with

34 559 members at the end of 2013,

a decrease from 40 724 at the end

of 2012.

There has been some movement from

2012 to 2013 in the positions ofrestricted schemes, with Platinum

Health moving down from number 5

to number 6, as a combined result of

a decrease in members on the scheme

and an increase in members on LA-

Health. The new schemes included

in this years analysis are LA-Health

Medical Scheme, SAMWUMED,

Sasolmed, Motohealth Care and

Profmed. Nedgroup Medical Aid

Scheme is the 11thlargest restricted

medical scheme with 27 328 members

at the end of 2013, compared toProfmeds 27 442 members.

Membership by medical scheme

-30%

-20%

-10%

0%

10%

20%

30%

0

200 000

400 000

600 000

800 000

1000 000

1200 000

1400 000

1600 000

Discovery

Bonitas

Mome

ntum

Medih

elp

Bestm

ed

Medshie

ld

Fedhealth

Libert

y

Sizwe

KeyH

ealth

GEMS

Polm

ed

Bankme

d

Tran

smed

LA-Health

Platin

umHealth

SAMW

UMED

Sasolm

ed

Motoh

ealth

Care

Profm

ed

Medical scheme

2013 principals 2013 dependants Growth in principal members Growth in dependants

Percentagegrowthfrom2

012to2013

Numberoflivescovered

9

DIAGNOSIS 2014/2015


10/36


11/36

Discoverys total market share based on

the number of principal members has

increased from 16% in 2001 to 31%

in 2013, compared to a decrease in

market share for the rest of the open

schemes from 54% in 2001 to 27%

in 2013. This decline in open medical

scheme membership (excluding

Discovery) is due to many members

and employers choosing to move fromtheir current medical scheme to join

Discovery and the transfer of eligible

public sector employees to GEMS since

its inception.

In 2013 GEMSs total market share

was 18%, compared to 2% in 2006.

The rapid growth in membership

includes eligible government

employees transferring from other

open schemes, the amalgamation

with Medcor in 2010 and the transferof a group of approximately 16 000

pensioners from Medihelp to GEMS

early in 2012. The increase in GEMSs

market share has also been assisted

by continued new member growth

stimulated by an attractive employer

subsidy. The total market share of

the balance of the restricted schemes

has decreased from 30% to 24%,

driven mostly by amalgamations of

restricted schemes into the open

medical scheme environment.

The industrys net growth of 62 836

principal members during the 2013

financial year was largely driven by

growth on Discovery Health Medical

Scheme (Discovery) with a net growth

of 51 897 principal members and the

GEMS with a net growth of 21 812

principal members. This growth was

partially offset by individuals leaving

the medical schemes industry, possibly

due to affordability constraints among

other reasons.

2.2 Market share

Market share by principal members

16%

54%

30%

27%

43%

28%

2%29%

30%

25%

16%

31%

27%

24%

18%

2006

2011

2001

2013

Discovery

2014:Altron, Afrox, PG Bison

2013:Nampak, IBM

2012:Edcon

2010:Afrisam, Umed2004:AngloGold

All open medical

schemes(excluding Discovery)

2001 to 2013:

Net reduction of 25 schemes

GEMS

2010: Medcor

2012:Pre-92 Medihelp pensioners

2001 to 2013:

Net reduction of 34 schemes

All restricted medical

schemes(excluding GEMS)

11

DIAGNOSIS 2014/2015


12/36

The average age of beneficiaries in

the medical schemes industry has

remained fairly constant since 2005

with a marginal decrease in the last

year, from 32 years in 2012 to 31.9

years in 2013. The trends for open

schemes and restricted schemes have

moved in opposite directions, however,

with the average age in open schemesincreasing by 2 years since 2005 (from

31.5 years to 33.5 years) and that in

restricted schemes decreasing by 2.3

years since 2005 (from 32.3 years to

30 years).

This divergence in the trends for

open and restricted schemes started

after 2006. This was the first year

of operation for GEMS and this

was combined with a change in theemployer subsidy for government

employees participating on GEMS.

The attractive subsidy appears to have

encouraged a consistent movement

of younger members from the open

scheme environment onto GEMS.

On the other hand, the subsidy

for pensioners who were previous

employees in the public service did

not change with the establishment of

GEMS and, as such, there has beenno incentive for these members to

consider transferring to the scheme.

2.3 Membership profile

Trend in average age of beneficiaries

Note:Average age and pensioner ratios were recorded in the CMS Annual Report from 2005 only.

25

26

27

28

29

30

31

32

33

34

35

2005 2006 2007 2008 2009 2010 2011 2012 2013


Year

Averageag

eofbeneficiaries

One of the most important contributing

factors to a schemes performance is the

risk profile of its members, with some of

the key statistics being:

Average age of beneficiaries

Pensioner ratio (defined as the percentage of

beneficiaries over the age of 65 years)

The following section considers these factors in detail.

12



13/36

With the consolidation experienced

in the industry over the last few

years, many restricted schemes have

amalgamated into the open medical

scheme market. Amalgamations

generally occur where schemes are no

longer sustainable due to membership

size, membership profile or poor claims

experience. As a result, restricted

schemes that have amalgamated into

the open medical scheme environment

as a result of poor claims or a poor

profile would have had a higher average

age. The exit of older than average

members from the restricted scheme

environment has therefore resulted in

a decrease in the average age.

The same argument explains the

increase in average age in the open

scheme environment.

As a scheme ages, we expect an

approximate increase in average

claims of 2% to 3% per year. This

is shown in the claims curve below,

together with a representation of

individuals general needs. Note that

specific needs will depend on an

individuals own circumstances.

Young and single

Hospital cover Limited or no

day-to-day cover

Family with children

Hospital cover Day-to-day cover

Maternity benefits Limited chronic benefits

Retired or retiring

Hospital cover Comprehensive day-to-

day cover Higher chronic benefits Cover for joint

replacements and other

age-related conditions

Middle-aged

Hospital cover Higher day-to-day coverChronic benefits

70+0 5 656055504540352515 302010

Averageclaimp

erme

mber

Age

Individual claims Family claims

13

DIAGNOSIS 2014/2015


14/36

While absolute age is important, the

changein average age also serves as

a key indicator for medical schemes

as any changes in profile would result

in the medical scheme needing to

take corrective action in its pricing

of benefits, especially if the age were

to increase.

Of the 20 schemes shown above,

KeyHealth and Transmed clearly

have the highest average age

of beneficiaries. Transmed is

characterised by an extremely high

pensioner ratio, due partly to the

voluntary nature of membership as

well as the post-retirement subsidy

offered to pensioner members.

Medihelp and LA-Health experienced

the largest decreases in the average

age of beneficiaries over the three-year

period. The decrease on Medihelp

was caused mostly by the transfer of

a large group of pensioners to GEMS

as noted earlier, while the decrease on

LA-Health was a result of significant

growth in younger members.

Average age of beneficiaries

-5

-4

-3

-2

-1

0

1

2

3

4

5

0

5

10

15

20

25

30

35

40

45

50

Discovery

Bonitas

Mome

ntum

Medih

elp

Bestm

ed

Medshie

ld

Fedhealth

Liberty

Sizwe

KeyH

ealth

GEMS

Polm

ed

Bankme

d

Transme

d

LA-Health

Platin

umHealth

SAMW

UMED

Sasolm

ed

Motoh

ealth

Care

Profm

ed

Changeinaverageage

Averageage

Medical scheme

Three-year change 2013

The following graph considers the average age of each of the schemes included in this years analysis.It also includes the change in the average age of each of the schemes from 31 December 2010 to

31 December 2013 (a three-year change).

14



15/36

Similar to the trends in the average

age, the pensioner ratio, defined as

the percentage of principal members

over the age of 65 years, of restricted

schemes has decreased in general

since 2005 while the pensioner ratio

in the open scheme environment

has increased since 2005. However,

the trend across schemes, whether

restricted or open, has been slowly

increasing in the last few years since

2011. This indicates that a higher

percentage of older and, most likely,

less healthy members are participating

in the medical scheme environment.

This is either as a result of fewer

younger members joining medical

schemes or younger members joining

at a rate that is not in line with the

rate of ageing.

The above may point to the question

of whether the current entry level

controls available to medical schemes

to manage anti-selective behaviour,

such as waiting periods and late joiner

penalties, are indeed sufficient to

manage the systemic risk of an open

enrolment environment.

Trend in pensioner ratio


0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

2005 2006 2007 2008 2009 2010 2011 2012 2013

Pensionerratio

Year

15

DIAGNOSIS 2014/2015


16/36

Medical schemes work on the

concept of risk pooling, where the

risk contribution charged to members

is based on a combination of

the following: The expected medical expenses

of the entire membership

group (claims) The costs associated with any

administration of claims and

day-to-day operations (non-

healthcare expenses) The interest or returns expected from

the schemes assets.

2.4 Contributions

Where the schemes claims and

expenses exceed contributions,

investment income is required to

subsidise this shortfall. Any remaining

investment income is then added to

the reserves of the scheme and serves

to increase its accumulated funds.

However, where investment income is

not sufficient to cover this shortfall, the

scheme is forced to use its reserves,

which serves to decrease accumulated

funds and hence solvency levels.

Although medical schemes are not

supposed to use investment income

when setting contribution rates, inreality, they are often forced to do so

for reasons including increasing costs

of claims, adverse claims experience

and cross-subsidisation between

benefit options.

The graph below considers the

allocation of risk contributions of the

top 10 open schemes, together with

the totals for open and restricted

schemes and the industry as a whole.

Where the contribution to reserves sits

below the 0% line, schemes have used

part or all of their investment income to

fund for claims and expenses. In some

cases, where investment income has

not been sufficient, schemes have hadto use their reserves, placing additional

pressure on solvency levels.

Contributions + Investment Income Claims + Expenses

In simple terms, medical scheme pricing

could be described by four main factors,

illustrated in the following equation:

Allocation of contribution income in 2013

Medical savings account Healthcare expenditure Non-healthcare expenditure Contribution to reserves

Percentageofgrosscontributionincome

Medical scheme

-10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

110%

Discovery

Bonitas

Momentum

Medihelp

Bestmed

Medshield

Fedhealth

Liberty

Sizwe

KeyHealth

GEMS

Polmed

Bankmed

Transmed

LA-Health

Platinum

Health

SAMW

UMED

Sasolmed

Motohealth

Care

Profmed

Open

Restricted

Industry

16



17/36

The diagram below compares medical

scheme contribution inflation, and

medical care and healthcare expense

inflation trends, to CPI inflation over

the past 14 years, where: CPI inflationis the weighted average

price inflation in different sectors

and indicates the general level of

price increases. Viewed in isolation,

it doesnt necessarily give a true

reflection of cost pressures in a

particular sector. Individual sectors

may experience cost increases that

differ from CPI inflation, as is the

case in the healthcare sector.

Medical schemes contribution

inflationis calculated for all medical

schemes who submit annual

financial returns to the Registrar

of Medical Schemes. Percentage

increases are based on the average

contribution per principal member

per month, and allow for normal

medical scheme contribution

increases, as well as buy-ups and

buy-downs to other benefit options.

Changes in contributions due to

family size or family composition are

also taken into account.

Medical care and health expense

inflationis measured by Statistics

South Africa and is based on that

component of CPI which relates to

doctors fees, nurses fees, hospital

fees, nursing home fees, medical

and pharmaceutical products and

therapeutic appliances.

2.5 Inflationary trends

Consumer

price inflation

5.8% per year

Medical scheme

contribution

inflation

7.5% per year

Medical inflation

7.9% per year

14-year period

Over the 14-year period, medical care and health expenses inflation has been on average 7.9% per year, while CPI

inflation averaged 5.8%, resulting in a gap of 2.1% per year. During the same period, average medical scheme

contribution inflation was 7.5% per year, resulting in actual increases in medical scheme contributions per principal

member exceeding CPI inflation by at least 1.7% per year.

The general rule of thumb used in the industry

is that medical inflation (medical care and

health expenses inflation) is approximately

2% to 3% higher than CPI inflation, with this

variance being mainly due to:

High increases in healthcare service provider fees A rising disease burden Increasing benefit utilisation New medical technologies The requirement to build reserves to 25% Certain benefit enhancements.

17

DIAGNOSIS 2014/2015


18/36

These differences in inflationary trends

have reduced in recent years and this

is most likely as a result of efforts by

medical schemes in managing the

costs charged by providers. While this

would have a direct impact on medical

scheme contribution increases, the

further reduction in the gap between

average medical scheme contribution

inflation and CPI inflation indicates

the extent of member buy-downs

to lower cost benefit options, new

entrants joining low-income options,

and changes to family size, possibly

through the removal of dependants due

to affordability constraints.

The graph below provides a high-level

indication of the average headline

contribution increases announced by

medical schemes from 2006 to 2014

and compares this to average CPI.

Note that we have taken an arithmetic

average for illustrative purposes

and have only included the medical

schemes where this information

is available. Also note that these

increases are based on the headline

increases announced by individual

schemes and the method of

calculation may vary. It does, however,

provide some useful information

regarding real contribution increases

faced by members.

Average contribution increases

0%

2%

4%

6%

8%

10%

12%

Discovery Bonitas Momentum Medihelp Bestmed Medshield Fedhealth Liberty Sizwe CPI

Averageheadlinec

ontributionincrease

Medical scheme

The average headline contribution increases for the top nine open

medical schemes have far exceeded average CPI since 2006; in fact,

by an average of 3.4%.

18



19/36

One of the main components

influencing the performance of

a medical scheme is its claims

experience. We consider the

claims ratio as well as the actual

level of claims that are paid by

medical schemes.

Healthcare expenditure includes all

payments made in respect of claims

incurred by members. The risk

claims ratio is defined as the ratio

of risk claims to risk contributions

(the proportion of contributions that

are used to fund claims, excluding

any allowance for medical savings

accounts). The risk claims ratio for

all medical schemes decreased to

86.4% in 2013 from 87.7% in 2012.

In 2013, open medical schemes had

a total risk claims ratio of 83.7%

compared to the 89.9% experienced by

restricted medical schemes.

Restricted schemes do not always have

to fund for certain non-healthcare

expenditure items such as distribution

costs and broker fees and, as a result,

can often afford to use a higher

percentage of risk contributions

towards risk claims than open

medical schemes. This trend is clearly

illustrated in the graph above.

The graph above also shows a cyclical

trend. This is most likely caused by the

lag effect of medical schemes annual

pricing exercises. Where a scheme

has experienced adverse claims

during the year, it would usually only

correct that experience through higher

contributions or benefit reductions

(and hence lower relative claims) in the

next financial year, and this corrective

action often needs to take place over at

least two years.

Medical schemes usually perform their

benefits and contributions reviews in

September of each year, using data

for only a part of that year. Where

experience has been adverse in the

first part of the year and is therefore

included in the data used for the

purposes of pricing, allowances can be

made to make up for this experience in

the next financial year. However, where

the adverse experience occurs in the

latter part of the year and has therefore

not been allowed for in the pricing of

benefits into the next year, this adverse

experience must be made up two

years later. In addition, the adverse

experience in the latter part of the year

has a direct impact on the reserves and

solvency levels of the scheme going

into the next year and this must also be

made up.

2.6 Healthcare (claims) expenditure

Trend in claims ratios

Open schemes Restricted schemes 85% lineAll schemes

Year

60%

70%

80%

90%

100%

110%

120%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Riskclaims

asa%o

friskcontributions

19

DIAGNOSIS 2014/2015


20/36

In general, medical schemes with a

risk claims ratio of above 85% face the

challenge of achieving an operating

surplus (contributions less claims

and expenses) while containing non-

healthcare expenses below the CMS

generally accepted guideline of 10% of

contributions and building reserves to a

sustainable level.

Although 85% is the generally

accepted benchmark for the claims

ratio, the ideal ratio for a particular

scheme will depend on its current

circumstances such as the current

adequacy of contributions, the level of

non-healthcare expenses, the need for

reserve building and the schemes long-

term strategy.

The graph below illustrates the average

claims and contributions paid per

beneficiary per month (PBPM), as well

as the risk claims ratio in 2013, for the

20 schemes included in the Diagnosis

this year. Only 5 of the 20 schemes

achieved a claims ratio below 85%.

While claims ratios indicate the

adequacy of contribution levels,

the actual average claims paid

per beneficiary indicate the level

of benefits provided by a scheme.

The graph above clearly shows that

KeyHealth paid the highest amount in

claims per beneficiary during 2013,

followed by Sasolmed and Fedhealth.

These three schemes also had thehighest contribution income per

beneficiary during the year.

The actual healthcare costs funded by

medical schemes are driven largely by

the distribution of members between

options, the profile of members, and

the structure of benefits provided on

various options, such as traditional or

new-generation plans.

The utilisation of services is influenced

by demographic factors (age profileand pensioner ratio), the incidence

and distribution of disease (often

called disease burden) and advances

in diagnostic technology and biological

drugs. However, owing to the errors in

the utilisation statistics contained in

the CMS Annual Report, as highlighted

by Circular 43 of 2014, we have not

included an in-depth analysis of the

latest utilisation statistics as we do

not feel that this would provide an

objective view of the current situation.

Claims and contributions by scheme

70%

75%

80%

85%

90%

95%

100%

R0

R200

R400

R600

R800

R1 000

R1 200

R1 400

R1 600

R1 800

R2 000

Discovery

Bonitas

Mome

ntum

Medih

elp

Bestm

ed

Medshie

ld

Fedh

ealth

Libert

y

Sizwe

KeyH

ealth

GEMS

Polm

ed

Bankme

d

Tran

smed

LA-Health

Platin

umHealth

SAMW

UMED

Sasolm

ed

Motoh

ealth

Care

Profm

ed

Riskclaimsratio

Averagecontribution/claimp

erbeneficiarypermonth(PBPM)

Medical scheme

Average contributions PBPM Average claims PBPM 85% line 2013 claims ratio

20



21/36

Non-healthcare expenditure (NHE)

includes administration fees, managed

care costs, broker commission,

distribution costs, bad debts and

reinsurance costs. The CMS has a

general guideline for medical schemes

of maintaining NHE at or below 10% of

contribution income.

Total NHE, as a proportion of gross

contribution income (GCI), decreased

very slightly to 11.1% in 2013 from

11.2% in 2012 and 11.3% in 2011.

The slight but steady decline in non-

healthcare expenditure since 2006

allows for a larger component of

member contributions to be available

for paying claims, which reduces the

need for higher future contribution

increases and allows for some level of

reserve building.

Restricted schemes are expected

to have lower non-healthcare costs

primarily because they have lower

or no distribution expenses or broker

fees and certain operating expenses

may be subsidised by the participating

employer(s).

In 2013, NHE as a proportion of

gross contribution income was 13.3%

(2012: 13.6%) for open schemes

and 8% (2012: 7.7%) for restricted

schemes. This low level of NHE within

restricted schemes is driven to a large

extent by GEMS. Excluding GEMS from

this calculation would result in NHE

as a proportion of gross contribution

income being 8.7% for restricted

medical schemes in 2013.

On the assumption that NHE increases

with CPI, whereas contributions

increase in line with medical inflation,

which is usually more than CPI each

year, we would expect the proportion

paid to NHE to decrease over time,

irrespective of whether additional cost

control measures are introduced. As a

result, a more suitable measure of NHE

is the absolute cost per member.

2.7 Non-healthcare expenditure

Trend in non-healthcare expenditure


Year

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

NHEasa%o

fGCI

10% line

21

DIAGNOSIS 2014/2015


22/36


23/36

2.8 Financial performance

Trend in operating results

Year

-R3 000

-R2 000

-R1 000

R0

R1 000

R2 000

R3 000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Operatingresult(Rmillion)

Open medical schemes Restricted medical schemes All medical schemes

There was a significant improvement

in the overall operating results of

the industry from 2012 to 2013.

In 2013, the industry managed

to achieve the most substantial

operating surplus since 2004: total

risk contributions exceeded risk claims

and non-healthcare expenses by

R1 551.78 million. Restricted

schemes achieved an overall operating

surplus of R925.24 million (2012:

R86.81 million) and open medical

schemes achieved an operating surplus

of R626.54 million (2012: deficit of

R61.06 million).

In 2013, 33% (8 of 24) of open

schemes and 57.1% (36 of 63)

of restricted schemes achieved an

operating surplus. By comparison,

48% (12 of 25) of open schemes

and 55.2% (37 of 67) of restricted

schemes achieved an operating

surplus in 2012.

One of the key factors used to measure the

performance of a medical scheme is the

operating result. A schemes operating result

is an indication of its financial soundness

after claims and non-healthcare expenditure

are deducted from contribution income.

It shows the surplus or deficit before

investment income. Drivers of strong financial

performance by medical schemes include:

Appropriate benefit pricing

Adequate risk management and claims control

Favourable age and risk profile of the

membership base

Low non-healthcare expenditure.

23

DIAGNOSIS 2014/2015


24/36

Schemes incurring operating deficits

have to rely on investment income to

achieve a breakeven result on a net

level. During 2013, the addition of

investment and other income resulted

in schemes achieving an overall net

surplus of R5 255.72 million. Open

schemes achieved an overall net

result of R2 332.16 million (2012:

R1 642.99 million) and restricted

schemes achieved an overall net

surplus of R2 923.56 million (2012:R2 047.59 million).

In 2013, 75% (18 of 24) of open

schemes and 93.7% (59 of 63) of

restricted schemes achieved a net

surplus. By comparison, 84% (21 of

25) of open schemes and 86.6% (58

of 67) of restricted schemes achieved a

net surplus in 2012.


the financial performance of the top 10

open schemes and top 10 restricted

schemes ranked according to size.

Trend in net results

Year

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Open medical schemes Restricted medical schemes All medical schemes

-R500

R0

R500

R1 000

R1 500

R2 000

R2 500

R3 000

R3 500

R4 000

R4 500

R5 000

R5 500

Netresult(Rmillion)

Schemes incurring operating deficits have to rely on investment

income to achieve a breakeven or positive result on a net level.

24



25/36

Schemes financial performance for 2013

-R200

R0

R200

R400

R600

R800

R1 000

R1 200

R1 400

R1 600

Discovery

Bonitas

Mome

ntum

Medih

elp

Bestm

ed

Medshie

ld

Fedhealth

Libert

y

Sizwe

KeyH

ealth

GEMS

Polm

ed

Bankme

d

Transm

ed

LA-Health

Platin

umHealth

SAMW

UMED

Sasolm

ed

Motoh

ealth

Care

Profm

ed

O

perating/netresult(Rmillion)

Medical scheme

Operating result Net result

Of the 20 schemes considered in this years Diagnosis, 10 did not manage to achieve a surplusat an operating level and therefore had to rely on investment income to subsidise claims and non-

healthcare expenditure during 2013. In addition, two schemes achieved a netdeficit which reduced

accumulated funds.

25

DIAGNOSIS 2014/2015


26/36

Where medical schemes do not

achieve surpluses at an operating

level, they become reliant on the

investment returns earned over the

year to fund part of their claims and

non-healthcare expenditure. In 2013,

49.4% (43 of 87) of medical schemes

failed to achieve an operating surplus

and therefore had to draw on their

investment returns, placing additional

pressure on solvency levels.

This strategy is not sustainable unless

investment returns are able to keep

pace with, and preferably exceed,

claims inflation. At present, however,

most medical schemes have adopted

very conservative investment strategies

as shown in the following graph. The

graph shows the asset allocation for

19 out of the 20 schemes under

consideration in this publication

and reflects what is available in the

schemes annual reports.

There are various asset class limits

placed on medical schemes in

Annexure B of the Regulations to

the Medical Schemes Act, but most

schemes are operating well inside the

limits for riskier asset classes. The limit

on equities is 40%, with the limit on

property being 10%. This implies that

schemes could have up to 50% of theirinvestments in these higher-risk asset

classes whose returns are generally

expected to exceed CPI inflation. The

allowable exposure to conservative

asset classes, such as cash, money

market instruments and bonds, is

unlimited. The only restrictions on

these asset classes are on the exposure

to specific issuers, to ensure some level

of diversification.

2.9 Investments

Asset allocation as at 31 December 2013

Note:The annual financial statements for Momentum did not provide enough detail to perform this analysis.

-10%

0%

10%

20%

30%

40%

50%

60%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Discovery

Bonit

as

Medih

elp

Bestm

ed

Medshie

ld

Fedhealth

Liberty

Sizwe

KeyH

ealth

GEMS

Polm

ed

Bankme

d

Transme

d

LA-Health

Platinum

Health

SAMW

UMED

Sasolm

ed

Motoh

ealth

Care

Profm

ed

Medical scheme

Solvency

Assetallocation

Cash & money market Bonds Equities Property Collective investment vehicles

Other Solvency

26



27/36


28/36

The solvency ratio is the level of

reserves (accumulated funds) that

a medical scheme needs to hold as

a percentage of gross annualised

contributions. Regulation 29

promulgated in terms of the Medical

Schemes Act (131 of 1998) prescribes

that medical schemes maintain a

minimum solvency ratio of 25%.

The graph below shows the solvency

levels of open and restricted schemes

against the statutory level over the

past 14 years. The increase in industry

solvency levels from 2000 to 2004 is

primarily attributable to the calculated

efforts of medical schemes to build

reserves to the prescribed minimum

solvency level that was required by

31 December 2004.

Restricted schemes on average have

maintained higher solvency compared

to open schemes. From 2006,

the solvency level for all restricted

schemes declined because of rapid

GEMS membership growth. The

average solvency of open schemes has

remained relatively stable since 2006.

In 2013, the average solvency for all

schemes was 33.3% (2012: 32.6%).

The solvency ratio of open schemes

increased to 29.7% in 2013 (2012:

29.1%). Restricted schemes solvency

levels increased for the first time since

2007, from 37.4% in 2012 to 38.2%

in 2013.

2.10 Solvency levels

In 2013 nine medical schemes

were unable to achieve the statutory

minimum solvency level of 25%:

Discovery Hosmed Liberty Pharos (amalgamated with Topmed on 1 January 2014) Resolution Thebemed

GEMS Transmed Umvuzo

Trend in solvency levels

0%

10%

20%

30%

40%

50%

60%

70%

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Solve

ncy

Year

Prescribed minimum solvency All open medical schemesAll medical schemes

Restricted medical schemes (excluding GEMS)All restricted medical schemes

28



29/36

The suitability of the current solvency

framework requiring schemes to

allocate a minimum of 25% of gross

contributions to reserves has long

been debated. Reasons that support

the need to revisit the current

framework include: Appropriateness of a one size fits

all approach. Medical scheme

claims experience is likely to be

more stable for larger schemes, so

the solvency requirements should

be less onerous, while solvency

requirements for smaller schemesshould be higher.

On the one hand, schemes showing

membership growth are penalised

from a solvency perspective. On the

other hand, schemes losing members

are rewarded. This is due to the

nature of the solvency calculation

formula. Therefore, schemes that are

growing are less competitive because

of the need to build and maintain

solvency levels.

Through Circulars 12, 17 and 28

of 2012, the CMS invited industry

stakeholders to make submissions onan appropriate solvency framework for

medical schemes.

Alexander Forbes Healths submission

proposes using a Risk Based

Framework as the most appropriate

measure for medical schemes in

South Africa. The Risk Based

Framework considers the size and the

specific risk exposure of a scheme

to measure the minimum amount

of capital required to support the

schemes overall operations.

To date, no feedback has been

received from the regulator, although

it is understood that many partiesprovided input into an appropriate

solvency framework.

Solvency levels by scheme

Medical scheme

Three-yearchange

Solvency

in

2013

Three-year change 2013 25% line

-25%

-15%

-5%

5%

15%

25%

35%

0%

10%

20%

30%

40%

50%

60%

Discovery

Bonitas

Mome

ntum

Medih

elp

Bestm

ed

Medshie

ld

Fedh

ealth

Libert

y

Sizwe

KeyH

ealth

GEMS

Polm

ed

Bankme

d

Transm

ed

LA-Health

Platin

umHealth

SAMW

UMED

Sasolm

ed

Profm

ed

Motoh

ealth

Care

The graph below illustrates the change in solvency levels from 2010 to 2013 for the 10 largest open and10 largest restricted schemes in terms of principal members. Four of these schemes failed to reach the

25% regulatory solvency level at the end of 2013.

29

DIAGNOSIS 2014/2015


30/36

3. Medical Schemes Sustainability Index

The Alexander Forbes Health Medical Schemes Sustainability

Index attempts to do this by combining certain key factors and

considering their impact to a medical scheme in future years. The

index has been calculated from a base year of 2006 and considers

the following factors:

With the continued consolidation of medical schemes in the industry as well as rising claims costs, thesustainability of medical schemes and the assessment thereof have become increasingly important for all

industry stakeholders. Throughout this publication we have analysed key statistics of medical schemes but

it is difficult to assess how their collective impact affects the sustainability of a medical scheme.

The size of the schemerelative to the average scheme size in the industry. A larger membership base would reduce

volatility in the claims experience and benefit from economies of scale.

Membership growthover time indicates that benefits are attractive. In addition, an increase in size serves to reduce

volatility of the schemes claims experience.

The change in the average ageof beneficiaries over time. An increasing average age indicates a worsening profile and

higher expected claims. This would require a medical scheme to adjust its base pricing for benefits through either

contribution increases or benefit reductions.

The operating resultof the scheme relative to the industry each year as this would indicate the medical schemes

performance relative to its peers.

The change in the operating resultper beneficiary each year. The operating result should give an indication of

the suitability of current contribution levels and whether higher or lower contribution increases can be expected

in the next year.

The change in the accumulated funds per beneficiaryheld at the end of each year. Accumulated funds essentially

act as a buffer against adverse claims experience, and an increase in the accumulated funds per beneficiary would

improve this buffer.

The schemes actual solvency relative to the statutory requirement. Although there is debate regarding the suitability of

the current statutory requirement, schemes whose solvency is below 25% are required to have business plans in place

with the CMS and their contribution increases would include an element of additional reserve-building going forward.

Higher than average contribution increases would have a negative impact on the schemes marketability.

The trend in the schemes solvency. Increasing solvency levels over time would also support the sustainability of a

medical scheme.

Using a base year of 2006, these

factors are considered for each of the

years from 2007 to 2013 with the final

index score reflecting the cumulative

impact over this period. The medical

schemes are ranked from highest to

lowest to give an indication of their

relative sustainability. It is important

to note that the purpose of the index is

to provide a comparative assessment

between schemes, and as such, the

relative positioning is more important

than the absolute score. It is also

important to note that small differences

in the scores (between 10 to 20 points)

are not material.


the 2012 and 2013 index scores for

each of the top 10 open and top 10

restricted medical schemes, using a

base year of 2006.

30



31/36

At an industry level, the index has

increased consistently since 2006.

This is driven by an increase in

the membership base, the level of

accumulated funds and the current

level of solvency of 33.3%. The index

has also consistently increased for both

restricted and open schemes. This was

driven by increased accumulated funds

and improving operating results for

open medical schemes and improvedsolvency levels and membership growth

for restricted medical schemes.

Sizwes membership base reduced

significantly during the year. This was

offset by an immediate improvement in

solvency and a significant turnaround

in the operating result (from a deficit of

R57.4 million in 2012 to a surplus of

R117.9 million in 2013).

A slowdown in the growth of

beneficiaries on GEMS, combined with

an improved operating result (from adeficit of R144.6 million in 2012 to

a surplus of R776.9 million in 2013),

improved the schemes solvency level

from 7.9% to 11.7%. Despite the

improvement in the index over the last

year, GEMS currently ranks at number

eight on the index due to an increasing

average age as well as solvency being

well below the regulated minimum

of 25%.

Discovery is currently ranked second

on the index owing to its increasing

membership and strong financial

performance over the last few years.

Despite its high ranking, the growth in

its index score has slowed down as a

result of solvency levels, which haveremained below the 25% requirement

since 2010.

The following two graphs show the

trend in Index scores from 2006 to

2013, for open and restricted medical

schemes respectively.

Medical Schemes Sustainability Index: 2012 and 2013 (base year: 2006)

Medical scheme

0%

5%

10%

15%

20%

25%

30%

0

50

100

150

200

250

300

Industry

Restrictedschemes

Open

schemes

Polmed

Discovery

Fedhealth

LA-Health

Bankmed

Medihelp

Sasolmed

GEMS

SAMW

UMED

Bonitas

Medshield

Momentum

Profm

edSizwe

Bestmed

Platinum

Health

KeyHealth

Liberty

Motohealth

Care

Transmed

C

hangefrom2

012to2013

Ind

exscore(baseyear:2006)

2012 2013 2013 change

In 2013, all of the top 20

schemes had an increase

in the index value, with

the largest increases seen

by Sizwe and GEMS.

31

DIAGNOSIS 2014/2015


32/36

There has been a general increasing

trend in index scores of open schemes

since 2006. Many schemes scores

have improved consistently over

this period, but some schemes,

such as Liberty and Medihelp, have

experienced a slowdown in this growth.

KeyHealth ranked near the bottom

for most of the last few years due

to solvency levels below 25% and

reducing membership levels. However,

steady improvement has been observed

since 2010, as solvency levels have

consistently increased and were above

25% for the first time in 2013. In

addition, the scheme has achieved

significant operating surpluses in

recent years, resulting in higher

accumulated funds.

Open scheme index trends

There has been a general increasing trend in index scores of open

schemes since 2006.

Index

score

Year

SizweMedshield Fedhealth Liberty KeyHealth

Bonitas Momentum BestmedMedihelpDiscovery

100

120

140

160

180

200

220

240

2006 2007 2008 2009 2010 2011 2012 2013

32



33/36

Polmed is currently ranked number

one on the index and has improved

significantly since 2010. This is due to

the schemes size, membership growth,

increasing accumulated funds and

solvency levels.

Although Transmeds index score

has improved in the last two years, it

still ranks last because of an ageing

profile, a continuous reduction in

membership and solvency levels below

the regulatory requirement of 25%.

Restricted scheme index trends

80

100

120

140

160

180

200

220

240

260

280

2006 2007 2008 2009 2010 2011 2012 2013

Index

score

Year

Motohealth CarePlatinum Health SAMWUMED Sasolmed Profmed

Polmed Bankmed LA-HealthTransmedGEMS

33

DIAGNOSIS 2014/2015


34/36

From this years analysis, the following key observations can be made:

The number of medical schemes decreased to 87 in 2013 from 92 in 2012.

The number of principal members increased marginally by 1.6% in 2013 (2012: 2.3%). Principal members in 2013 totalled

3 878 267 (2012: 3 815 431).

The average age of beneficiaries has decreased slightly to 31.9 years in 2013 (2012: 32 years), with the pensioner ratio

remaining stable at 7.1%.

Family size has continued to decrease. In 2013 the average family size was 2.26 compared to 2.27 in 2012.

The risk claims ratio for all schemes decreased to 86.4% in 2013 (2012: 87.7%).

Total non-healthcare expenditure as a percentage of gross contribution income remained stable at 11.1% in 2013.

In 2013, 50.6% (44 of 87) of schemes achieved an operating surplus. By comparison, 53.3% (49 of 92) of schemes achieved

an operating surplus in 2012.

During 2013, most scheme assets were held as cash, either in bank accounts or via money market instruments.

The average solvency for all schemes increased to 33.3% in 2013 compared to 32.6% in 2012.

All 20 schemes included in this years analysis experienced an increase in the Medical Schemes Sustainability Index value.

4. Conclusion

Despite this, the medical schemes industry in South Africa

faces unique challenges in the build-up to full implementation

of National Health Insurance. The demarcation between health

insurance policies and medical scheme cover, findings of

the inquiry into private healthcare sector pricing and further

regulatory reform by way of the Medical Schemes Amendments

Bill are likely to transform the landscape of private healthcare

funding over the next decade.

The 2013 financial year saw

continued consolidation through

the amalgamation of unsustainable

medical schemes, which should

serve to improve the sustainability

of the industry as a whole. In

addition, the profile of the industry

is mostly stable and the overall

financial position is sound.

34



35/36

For more information please contact:

5. Alexander Forbes Health

Technical and Actuarial Consulting Solutions (TACS) is a professionalindependent actuarial and consulting unit within Alexander Forbes

Health (Pty) Ltd. The Alexander Forbes Health team has been

delivering innovative and customised healthcare solutions to corporate

clients, medical schemes and individuals since 1991.

We would like to thank the following members of the Technical and Actuarial Consulting

Solutions (TACS) and Research & Product Development teams for their contribution to this

years publication:

Cecilia Augustine

Stefan Bekker

Roshan Bhana

Anne Cabot-Alletzhauzer

Kristin-Ann Cronj

Natalie De Wit

Anthea Towert

Amy Underwood

Sources:Council for Medical Schemes Annual Reports (2000 to 2013). Audited annual

financial statements of medical schemes.

Roshan BhanaBranch Head: [email protected] 269 1798

Casper De VriesActuarial (Coastal), [email protected] 809 3626

Anthea TowertScheme Consulting, [email protected] 269 0507

Kristin-Ann CronjResearch & ProductDevelopment

[email protected] 269 0814

Alison CounihanActuarial (Sandton), [email protected] 269 0557

35

DIAGNOSIS 2014/2015
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


36/36

Head office Sandton

Alexander Forbes, 115 West Street, Sandown

PO Box 787240, Sandown, 2146

Telephone (South Africa): 011 269 0000

Telephone (international): +27 11 269 0000

Fax (South Africa): 011 263 1111

Fax (international): +27 11 263 1111

Pretoria

Alexander Forbes House,

189 Clark Street, Brooklyn, Pretoria

PO Box 2435, Pretoria, 0001





Cape Town

Block A, The Boulevard, Searle Street,

Woodstock, Cape Town

PO Box 253, Cape Town, 8000


Telephone (international): +27 21 401 9300Fax (South Africa): 021 415 5580


Stellenbosch

40 Dorp Street, Stellenbosch

PO Box 501, Stellenbosch, 7599





Durban

Alexander Forbes Place,

10 Torsvale Crescent, Torsvale Park,

La Lucia Ridge Office Estate, La Lucia

PO Box 782, Umhlanga Rocks, 4320





Port Elizabeth

256 Cape Road, Newton Park,

Port Elizabeth

PO Box 27972, Greenacres, 6057

Telephone (South Africa): 041 392 8300Telephone (international): +27 41 392 8300



East London

1stFloor Short Mill House,

Quarry Office Park, Berea, East London

PO Box 19367, Tecoma, 5214





Bloemfontein

8-10 Reid Street, Westdene,

Bloemfontein

PO Box 12731, Brandhof, 9324





Telephone: 011 269 2690

Fax: 011 263 2397

[email protected]

Alex Forbes Diagnose 2014

Documents

Transcript of Alex Forbes Diagnose 2014