council formedical schemes reports/2004-2005 cms annu… · by colin richards) and comes from the...

COUNCIL FOR MEDICAL SCHEMES

1267 Pretorius Street, Hadefields Block E, Hatfield, Pretoria

Private Bag X34, Hatfield 0028

Telephone: 012 431 0500 Telefax: 012 430 7644

www.medicalschemes.com

C o u n c i l f o r M e d i c a l S c h e m e sA N N U A L R E P O R T 2 0 0 4 - 5

1267 Pretorius Street, Hadefields Block E, Hatfield, Pretoria

Private Bag X34, Hatfield 0028

Telephone: 012 431 0500 Telefax: 012 430 7644

www.medicalschemes.comNumber: RP146/2005

ISBN: 0-061-36049-X


S t r a t e g i c O b j e c t i v e s

Secure an appropriate level of protection forbeneficiaries of medical schemes and thepublic by authorising the conduct of medicalschemes business and monitoring the financialperformance and soundness of schemes.

Provide support and guidance to trustees andpromote understanding of the medicalschemes environment by trustees,beneficiaries and the public.

Foster compliance with the Act by medicalschemes, administrators, managed care entitiesand brokers and initiate enforcement actionwhere required.

Investigate and resolve complaints raised bybeneficiaries and the public.

Monitor the impact of the Act, researchdevelopments, and recommend policy optionsto improve the regulatory environment.

Foster the continued development of theCMS as an employer of choice.

Develop strategic alliances nationally,regionally and internationally.

Council for Medical SchemesA N N U A L R E P O R T 2 0 0 4 - 5

The imagesThe selection of images was made with theassistance of the Wits Art Gallery, to reflectnotions of health and the exchange of money inmany cultures in South Africa and the continentas a whole, many of which live side-by side in asetting which supports medical schemes. Thesetwo items (health and the exchange of money),very roughly mirror the business of medicalschemes.

The artwork reflected in the Annual Report2004/05 belongs to Wits University andStandard Bank Collections of Art. The Councilfor Medical Schemes expresses its gratitude forthe use of these images and in particular forthe assistance given by Julia Charlton, seniorcurator of the Wits Art Gallery.

PREVIOUS PAGE

● A DIVINER’S BASKET with the objectsnecessary for divining and therapy to deal withillness or “re-establish order in the vitalrelationships between people, and betweenpeople and the spiritis” (Boris Westliau quotedby Colin Richards) and comes from the Chokwepeople of Angola and the Democratic Republicof Congo.

● AIDS CLOTH byNoria Maswanganyi& Florence Nobelaof the ChivurikaEmbroidery Project.

c o n t e n t sChairperson’s foreword 5

Registrar’s overview 9

Report of the Auditor-General 37

Balance sheet 39Income statement 40Statement of Changes in Equity 41Cash flow statement 41Notes to the Financial Statements 42

Review of the operations of medical schemes during 2004 53

Annexures 87

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4 COUNCIL FOR MEDICAL SCHEMES Annual Report 2004-5

Chairperson’s foreword

IT IS with considerable pride, but some nostalgia, that I present this foreword to

the Annual Report of the Council for Medical Schemes for 2004/05, as my tenure

chairing the Council draws to a close. During 2005, the terms of office of several

other Council members also come to an end. They are Ms Gando Matyumza

who has been an able deputy chairperson, Professor Heather McLeod,

Dr Jakes Jekwa and Dr Reno Morar.

I would like to thank them for the tremendous effort they put into

the work of the Council over the past five years. I am sure too that I

speak for all of us when I say that we are most grateful for the opportu-

nity afforded us to participate in the Council, and that we will miss

the dynamic and rewarding interactions we have enjoyed here.

We wish our successors as much fulfillment in their positions as

we experienced.

Over these past five years both the regulator and the industry

have experienced fundamental transformation – which contin-

ues. There is little comparison between the level of regulatory

oversight exercised in the medical schemes industry prior to

the creation of the new Council for Medical Schemes and

Office of the Registrar in 2000, and what is now in place.

In 2000, when the current Medical Schemes Act became

operational, the industry was regulated by a sub-direc-

torate in the Department of Health. This was inadequate

to regulate the then R30bn which was spent annually by

some 7-million beneficiaries in the industry while, at the

same time, ensuring that members and their dependants

were treated fairly in terms of the law, and ensuring an envi-

ronment which would function well into the future. A regulatory

structure was therefore created which would have the capacity and flexibility to

redirect further development of the private health funding sector in a manner con-

sistent with national health policy being rolled out by the first democratically-

elected government.

Inequities and unfair practices which had developed for members over the pre-

vious years, were now to be outlawed by the Medical Schemes Act, but this

required a strong and adequate regulator to translate the law into a useful reality

for members while protecting the financial security of schemes then and into the

future. This, in turn, called for the overseeing of specific moves: the promotion of

1

COUNCIL FOR MEDICAL SCHEMES Annual Report 2004-5 5

● Medicine containersThese calabashes are used byritual specialists as containersin which to store medicines.

Pare,Tanzania

Gourd, wood, fabric, fibre, beads

Standard Bank FoundationCollection of African Art - Housedat the University of theWitwatersrand Art Galleries

Acquired 2004

non-discriminatory access to private health care funding; the placing of schemes

on a sound financial footing; the improvement of scheme governance; and the

protection of consumers.

One of our first tasks as the Council was ensuring that the new regulator itself

had impeccable system of corporate governance. We therefore defined our role as

Council to include:

• leading and controlling the affairs of the organization and making strategic

decisions affecting the operations of the organization;

• exercising those legislative functions set aside by the Act to be exercised only

by Council and taking specific decisions that are judged by the Registrar and

Council to be of such significance as to require being taken by Council;

• setting appropriate policies to manage risks to the operations and achievement

of Council’s regulatory objectives, taking into account the nature and extent of

risks facing the Council, their likelihood of crystallising, and the Council’s

ability to reduce the incidence and impact of risks that do materialize;

• maintaining a sound system of financial controls, taking into account the costs

of particular controls relative to the benefits obtained in managing related

risks; and

• maintaining high-level relations with stakeholders and other agencies, includ-

ing government.

This corporate governance framework has served

us well over the years, and we hope that our

successors will build on it.

We also adopted a Code of Good

Conduct, which is underpinned by

the requirement that all Council

members bring independent judg-

ment to bear on issues of strategy,

performance, resources and stan-

dards of conduct. Other important

components of the Code include

access to suitable training, advice and

information, supplied in a timely manner, and in

a format and quality appropriate to enable Council to

discharge its duties. Again we recommend this code of conduct to

the new Council and hope that the code can be improved upon as new circum-

stances emerge.

We have seen, over the past five years, initial resistance by some stakeholders

giving way to a generally enthusiastic participation in a newly-invigorated indus-

try which is on a much sounder footing financially and ensuring greater assistance

towards its members. There is always room for improvement in any situation, but

we believe that our increased regulatory capacity has translated into a more-pro-

fessional and useful service matched by growing levels of cooperation and mutu-

al respect between ourselves and industry stakeholders.

In 2000, close to 50% of members of schemes belonged to schemes with sol-


C H A I R P E R S O N ’ S F O R E W O R D

1

● Diviner’s necklacePart of the regalia wornby a sangoma ortraditional healer whenconsulting with andtreating clients.

Wood, thread, glass beads,leather

Standard Bank FoundationCollection of African Art -Housed at the University ofthe Witwatersrand ArtGalleries

vency levels of less than 10%. In 2000, the regular annual deficit schemes made

had amounted to R1bn. I leave office with the vast majority of members in

schemes which meet the statutory minimum solvency levels of 25% or more, and

with the industry now regularly making large surpluses. We have achieved suc-

cesses in the areas of minimum reserve requirements, more stringent financial

controls within medical schemes, and closer scrutiny of the financial affairs of

medical schemes. A stronger awareness of the need for good governance also

exists, with participation of trustees and consumer groups in educational pro-

grammes that the Registrar has set up.

As the Council goes forward, it looks to the creation of a Risk Equalisation

Fund for the industry as well as continued participation in the creation of a Social

Health Insurance system.

As a Council, we were very fortunate that the Minister of Health, Dr Manto

Tshabalala-Msimang took a very active interest in our work over the years. The

Minister’s support on key regulatory measures -- such as curbing the abuse of rein-

surance, setting out appropriate requirements for prescribed minimum benefits

and medical schemes governance -- has been very important to many of the sem-

inal successes of the Council. I take this opportunity to thank the Minister for her

considerable assistance and counsel to us as Council.

In closing, I would like to pay particular tribute to the Registrar, Patrick

Masobe, for his leadership of the executive arm of the Council. Under his direc-

tion, a regulatory body has emerged that has demonstrated vision, the ability to

be flexible under appropriate circumstances, and the tenacity to remain resolute

when key issues of policy and principle are at stake. I have every confidence that

the Registrar and his team will continue to build on their successes, learn from

their mistakes, and boldly confront the challenges that lie ahead. I wish them well.

Prof Nicky Padayachee

Chairperson – Council for Medical Schemes

C H A I R P E R S O N ’ S F O R E W O R D

1



● Isijolandi (medicine necklace)Zulu, South Africa

Glass beads, horns, plastic spoons


Also see necklace on page 13.


2

Registrar’s review

External developments affecting our workThe past year has seen a number of important policy developments that, though

not part of our regular agenda, have nonetheless impacted on our work. These

external factors have affected the experience that beneficiaries had of their medical

schemes and we have had to expend much effort on addressing these issues.

Central to these has been the promulgation of the new regulations on the pricing

of medicines and the Competition Tribunal hearings on the proposed sale of the

Afrox hospital group to a consortium made of Mediclinic and its black econom-

ic empowerment partners.

Regulation of medicine prices

Medical schemes and their beneficiaries expressed a great deal of

uncertainty over the implications of the new medicines pricing

regulations in the light of legal challenges mounted against

these regulations by a number of parties in the private sector.

Those needing medicines for the compulsory cover of the 25

prescribed chronic conditions were faced, too, with added

costs when pharmacists decided to charge “administrative” fees

that were not reimbursed by medical schemes. We were, as a con-

sequence, inundated with queries both from medical schemes and

from beneficiaries expressing their anxiety over the implications of

the medicine-pricing regulations. A considerable amount of our time

was spent jointly with the health department responding to beneficiaries’ com-

plaints and to schemes’ enquiries. While a judgement from the Constitutional

Court on the legality of these regulations is still awaited, it would appear that the

promise of lower medicine costs is in sight, with manufacturer prices estimated to

have decreased by 21% since May 2004.

Competition Tribunal hearings and the Afrox Healthcare transaction

We were called upon to assist the Competition Tribunal in its deliberations on the

likely impact of the proposed transaction on hospital costs. This was done with a

submission on behalf of the Minister of Health and of the Council and then by

providing expert help at the hearings. Hospital costs are the largest portion of

● A medicine gourd, ornhunguvana. “Such objectsare more and less thanstethoscopes or antibiotics,”says Rayda Becker describingthe object and its relationshipto its users – and the distancefrom its Western oberservers.It rests in a beaded basketknown as a xitebana and theNhlontwa, the head on the topof the stopper (with a stirringdevice) has been separatelycreated Tsonga-Shangaan, South Africa.

medical scheme input costs, and our work at the Tribunal gave us an opportunity

to look critically at competition in the hospital industry with an eye on the effect

this has on costs to the public in general and medical schemes in particular. The

outcome of the Tribunal hearings resulted in a complete restructuring in the

financing of the deal in which the BEE consortium bought the interests of Afrox

Healthcare from the parent group and the complete disappearance of Mediclinic.

New developments in the regulatory regime

We advanced the improvement of the medical schemes regulatory framework on

a number of fronts during the year under review. In this section we report on

some of the more important changes to the regulatory regime.

Mitigating against unfair discrimination in benefit design

We have found it necessary to scrutinise more thoroughly the construction of ben-

efits and certain practices that have grown over the years in benefit design in order


REGULATING IN THE PUBLIC INTEREST: Taking stock and looking to

A Five-Year Review of the Council for Medical Schemes

AS THE Council for Medical Schemes

approached the end of its fifth year

of operations in 2005, the Registrar

published a review and analysis of

the first five years of the Council.

The review will provide a basis for

critical reflection on progress and lay

the platform for future actions. It will

be provided to the Minister of Health

for her consideration in relation to

the requirement to assess Council’s

performance every five years.

The Council was established

to protect the interests of

beneficiaries of medical schemes, to

ensure that medical schemes func-

tioned in a way which comple-

mented national health policy and

to make recommendations to the

Minister of Health.

The review outlined the setting up

of the Council and of the Office of

the Registrar and set out the strategic

objectives of the organization while

assessing its accomplishments and

shortcomings over the period.

Financial soundness of medical

schemes formed a major focus of the

early years of the regulatory effort. By

2000 an increasing annual deficit in

the industry had reached R1bn. To

address this, it became apparent that

the growing phenomenon of the

inappropriate use of reinsurance in

the industry, needed to be addressed.

Other areas highlighted in the

review include progress on managing

rules of schemes, simplifying benefits

● Umdwana (Child figure ordoll). Different uses for thedolls are recorded; somerelated to fertility, others toornamental or decorativepurposes, and still others toidentity statements.Ndebele, South Africa

Gourd, beads, fibre


R E G I S T R A R ’ SR E V I E W

2

to allay continuing concerns of unfair discrimination against some members of

schemes. This work represents, in part, our attempt to implement the recommen-

dations made in our Fair Treatment of Members project, where members

expressed their displeasure at unnecessary complexity of benefit design.

Part of the problem is manifest in the increasing trend to moving, as far as pos-

sible, benefits out of the risk pool and of forcing members to pay for increasing

amounts of healthcare from medical savings accounts and the so-called annual

routine benefits. Another problem relates to the differentiation of total contribu-

tions within a single-benefit option based upon variable contributions to a med-

ical savings account.

These various configurations of medical savings accounts, annual routine ben-

efits, thresholds and deductibles have largely had the effect of creating a de facto

risk-rated contribution for out-of-hospital expenses, based on age and health sta-

tus. In other words, for out-of-hospital expenses, over a period of time the actual

contribution payable by a member begins to approximate the rate payable by that

member based on expected claims of that member and her or his dependants, as

opposed to a community-rated contribution based upon an expected average cost

for the medical scheme.

Towards the end of 2004, we informed schemes that these benefit designs were


2

the future

provided by schemes and constructing a

compliance-based regime for the setor.

The review notes that in the past

five years progress was made in pro-

moting non-discriminatory access to

private health funding. Practices of

overt and direct discrimination on the

basis of age and health status were

largely contained – but structural

problems emerged which have result-

ed in older and sickly members facing

greater financial obstacles in gaining

access to health care.

Scheme governance falls among

four broad thematic concerns which

the report regarded as critical factors

going forward. Price-setting behaviour

by schemes and providers formed a

second concern; rationing in a setting

of scarce resources produces decisions

which have to be made on limitations

to health care; and a final concern,

the report noted, is the appropriate

regulation of the use of expensive

technology.


neither acceptable nor legal and that they had to be ended. They result in unfair

discrimination directly or indirectly against persons on grounds of state of health,

contrary to section 24(2) (e) of the Medical Schemes Act, and they constitute a cir-

cumvention of the provisions of the Act.

Implementation of ICD 10 codes

The purpose of the new coding system is to standardise data collection and billing

practices in order to improve efficiency. An ICD 10 implementation task team --

including department of health, medical schemes and administrators, providers

and switching companies -- was formed to develop an implementation strategy

for ICD 10 for medical schemes. The task team has evaluated the readiness for

implementation by schemes, providers, switching companies and other relevant

stakeholders. It was decided that the ICD-10 codes should be implemented

on1July 2005.

The process of further consultation with stakeholders is continuing, with

many aspects that will need to be dealt with in the course of the actual imple-

mentation after July 2005.

The 15 PMB chapters have also been coded for ICD10, and they now

form the basis of our interpretation of members’ entitlement to PMBs. This

process, while appearing to be removed from the immediate sphere of

member interest, will directly affect the way in which members are reim-

bursed. It will require significant effort in educating stakeholders as well

as members so that the system can deliver its objective of efficiently reim-

bursing for conditions that are being treated and for which schemes are

obliged to pay in full.

The National Health Reference Price List (NHRPL)

For the second consecutive year we have undertaken the task of compil-

ing a reference price list of services supplied into the medical scheme

environment. Although not initially a core function of the CMS, the

move in the year 2003/04 to provide the list was necessitated by action

taken by the Competition Commission in curtailing the annual negoti-

ations between the medical schemes industry through the Board of

Healthcare Funders and hospital and doctor groups. This move had created

an impasse in the medical schemes environment and the Council stepped in to

compile a reference price list that schemes could use to define their benefits

should they wish.

During 2004, state hospital prices and services were included in the list at the

request of the department of health. The intense level of work required on this list

and the persistent nature of inquiries from stakeholders necessitated the employ-

ment of one extra staff member during the year. Some changes to the compilation

of the list were reflected in the outcome of the pricing exercise. The previous

approach of keeping price increases “cost neutral” was changed where necessary,



2

● Katatora (divinationinstrument) Divinationinstruments such as these areused by ritual specialists inthe consultation of spirits.Luba, Democratic Republic ofCongo

Wood, beads

Standard Bank FoundationCollection of African Art - Housed at the University of theWitwatersrand Art Galleries

particularly when there

was solid evidence of higher real

input costs. However in the absence of adequate justification, the year’s CPIX infla-

tion figure of 5,2% was adhered to.

Risk Equalisation

We continued to assist the department of health with the technical work on the

development of policy on the Risk Equalisation Fund (REF). The Council has now

been requested by the department to proceed with the testing of the REF scheme

to assist government in coming to a final decision on its implementation.

A number of technical documents were completed in this regard during this

year. They include:

• Methodology for the determination of REF contribution tables;

• Accounting and financial implications of the REF for medical schemes – done

together with SAICA; and

• Solvency implications of the REF for medical schemes.

A reporting framework for medical schemes, including the necessary return that

will allow for submission by schemes of the data required for the shadow REF run,

has been finalised. We are also in the process of completing a review of the feasi-

bility of implementation and the technological and institutional infrastructure

required to operate the REF. As this report was going to press, Cabinet announced

its approval of the implementation of the REF

Prescribed minimum benefits

The Minister of Health introduced amendments to the HIV/AIDS PMBs on 1

January 2005 to make provision for the payment by medical schemes of anti-

retroviral therapy treatment.

Consultations on the setting up of a REF have also provided the impetus to

research defining a basic benefit package that will facilitate the implementation of

risk equalisation among schemes. A preliminary set of principles that will guide

the process of the development of a basic benefit package has been developed.

During September 2004, three members of staff who are directly involved in the

project visited the Netherlands, Ireland, and the state of Oregon in the USA to

learn more about developing a basic benefit package. We expect this work to gath-

er momentum during 2005/06.


● Necklaces such as this wereworn by ritual specialists,medical practitioners and theirclients to store medicines andother powerful substances.Zulu, South Africa

Umgexo (medicine necklace)

Glass beads, test tubes


These preliminary results also show that that

use of formularies and protocols chronic medi-

cines has increased to 85% of open schemes from

33.6% prior to the regulations coming into force.

The use of protocols also increased to 64,5% from

34,2% in restricted schemes.

Access to medical schemes by people with low incomes

Also as a result of the REF consultation process, and with an eye on how best to

deliver less-expensive benefit options which would cover those with some income

but who are presently not covered by the medical scheme industry, focus has been

given to the possibility of developing a low-cost medical scheme environment.

This project, again undertaken with the industry, is reviewing issues both on

the demand and on the supply side that constrain the development of low-cost

options within medical schemes. We expect recommendations to be made during

January 2006, and these will then be assessed for their policy implications.

Assessing the impact of chronic disease list and designated serviceproviders.

The introduction of compulsory cover for 25 chronic conditions with arrange-

ments made for provision of services through designated service providers has

now been in effect for more than a year. We have undertaken a substantial drive

to make the public aware of these arrangements. While the basic objective of

ensuring that schemes provide cover for these diseases has been achieved, it

became clear during the year that some schemes used this opportunity to cease

covering other chronic conditions that were not included within the legislated 25.

In addition, we have had to intervene in the reluctance of certain schemes to sup-

ply cover for treatments that may, for medically sound reasons, have varied from

the treatment algorithm attached to the chronic conditions.

A project to monitor the impact of the legislation on designated service

providers and on the chronic disease list is underway. The primary purpose is to

gain an improved understanding of the impact of these new policies on a range of

issues including delivery of PMBs, changes in benefit design and contributions,

and the impact on schemes, beneficiaries and providers. Preliminary findings

indicate that the CDL legislation has improved healthcare delivery to scheme

members in respect of the 25 chronic conditions. Coverage for chronic medica-

tion increased from 86.6% in 2003 to 100% in 2004 among open schemes.

57.5% of open schemes options also provided cover for the non-statutory chron-

ic conditions whilst the balance only provided

cover for conditions on the CDL. The cover for

chronic medication in the restricted schemes envi-

ronment increased from 78.4% to 100%. 71.1%

of restricted scheme options also provided bene-

fits for non-statutory chronic medication.



2

CDL CDL and Non Statutory Chronic No benefit Unknown

Open Restricted Combined Open Restricted Combined2003 2004

12.60 21.60 16.10 57.50 71.10 62.80

86.6078.40

83.40

42.50

28.9037.20

0

20

40

60

80

100%

Figure 1: Chronic medication coverageFigure 1: Chronic medication coverage

Finally, our research found that a total of 78.2% of all options used DSPs in

2004, against only 45.3% in 2003. The use of DSPs in 2004 included those for the

CDL and non-statutory chronic conditions. It

would appear that DSP arrangements have been

identified as a useful strategy for managing risk.

While this increase is encouraging, neither the

registered rules of the schemes nor the member

communication are consistent in the identifica-

tion of the DSP. The communication often just

states that a DSP has to be used without stipu-

lating who the DSP is. It was not clear whether

this had been communicated to members in

other ways.

The second phase of the research will be

completed by October 2005, and will focus par-

ticularly on the impact on costs, beneficiaries

and providers.

Medical schemes expenditure on privatehospitals

Our participation in the Competition Tribunal

hearings has also provided some impetus to an

aspect of our investigation into the cost drivers

in medical schemes. Figure 4 below shows real

expenditure on private hospitals by medical

schemes on a beneficiary per month, over an

eight-year period. After adjusting for inflation

and membership, the overall expenditure on

hospitals rose by 17,3% to R186,6 per benefici-


2


CDL CDL and Non Statutory Chronic No Formulary


20.80 35.50 26.5066.40 64.90 65.80

38.30

19.7031.10

33.60 35.10 34.2040.80

44.70 42.30

0

20

40

60

80

100%

CDL CDL and Non Statutory Chronic No DSP


19.00 26.30 21.8060.20 44.80 54.70

28.1028.90

28.40

39.80

55.20

45.3052.90

44.7049.70

0

20

40

60

80

100%

Figure 3: Use of designated service providers in schemes

97 98 99 2000 01 02 03 040

40

80

120

160

200

Ward fees Theatre fees Global and Per Diem Consumables Medicines

month in 2003 Rand terms)

Figure 2: Changes in the use of formularies and protocols for chronic medications

Figure 3: Use of designated service providers in schemes

Figure 4. Real expenditure on private hospitals (per beneficiary per month in 2004 prices)

ary per month in 2004 from R159 in 2003. Ward fees increased by 20,4% to R74,8

from R62,1 in 2003. The highest increase was for theatre fees, which rose by

35,6% to R42,3 from R31,2 in 2003. Medicines increased by 16,4% to R31,6 from

R27,2 in 2003.

Total private hospitals expenditure has increased by an inflation-adjusted

103,1%, since 1997. Ward fees increased by 85,8%; consumables by 63,1%

and medicines by 122%. Theatre fees have risen by 172%!

Of particular concern is the fact that private hospitals are oper-

ating in a largely unregulated environment and that medical schemes

provide little effective countervailing market power to that of the major

hospital groups. We have therefore initiated an intensive research project

on medical schemes’ expenditure on private hospitals, with the following

three objectives:

• To assess the impact and extent of escalating private hospital

costs in relation to medical schemes expenditure;

• To identify and evaluate the causes of current and his-

torical rates of escalation of private hospital costs in South

Africa; and

• To identify and recommend possible remedies to reduce

the rate of private hospital cost escalation, to the extent that it

may be found to be inappropriate, and to mitigate the effects

thereof.

This project is expected to generate a consolidated final report by March 2006.

Our work with regulated entities - medical schemes,administrators, managed care organisations and brokers

Risk-based regulatory framework

The Council takes a risk-based approach to regulation, and the intensity of our

work with specific schemes depends on whether or not they are among those clas-

sified as high impact. During the year, we developed risk assessment frameworks

and risk mitigation plans for a number of schemes, including Fedhealth, Bonitas,

Oxygen, Discovery Health, Spectramed and Bankmed. The trustees have been

briefed on our view of the risks within their schemes and measures to mitigate

them. We will now monitor the implementation of specific mitigation plans while

we continue to roll out the development of risk assessment and mitigation plans

to other high impact schemes.

Promoting financial health of schemes – and treating their ills

Several schemes are on our monthly monitoring programmes to assist in restor-



2

● Katanga copper crosses,

See page 35.

ing them to good financial health. Our work in this regard has

focused on:

• POLPRISMED – we appointed a compliance officer to this

scheme who was instrumental in turning its deficit position

into an operating surplus by year’s end. The scheme is

now in the process of finalising an amalgamation

with HOSMED.

• LIBERTY medical scheme remains on the monthly monitoring

schedule. Monitoring of performance against a business plan

agreed between the Registrar and the trustees of the scheme forms

the basis for the monthly meetings. The solvency position of the

scheme has improved from 10,05% in 2003 to 20,78% by

December 2004.

• PROTECTOR HEALTH medical scheme’s financial position has not

improved much over the last financial year, and the scheme remains

under constant watch.

• X-PRESS’s (Renaissance Health) solvency declined to 11,52% for the year ended

December 2004. The scheme has been placed on our monitoring schedule.

• MUNIMED incurred losses on two of its options, resulting in declining solvency.

The scheme has been placed on watch and will be monitored carefully in line

with the agreed business plan.

• PHAROS medical scheme has seen a slight improvement to 15,34% from

13,49% during 2002 in its solvency and will remain on monitoring.

• OXYGEN medical scheme’s solvency declined to 16,25%% from 25,64% during

the period under review, with a number of options making operating losses.

The scheme has been instructed to redesign these options and is now on our

monthly watch list.

• GLOBAL HEALTH’s solvency declined to 20,61% in 2004 from 26,98% in 2003.

The scheme has been instructed to provide monthly management accounts.

• PROFMED has improved solvency to 22,04% in 2004 from 8,83% the previous

year after considerable restructuring of benefits and administration. The

scheme remains on our monitoring programme.

• SEDMED, NBC and NIMAS have been placed under monitoring as they are still

below the required 25% solvency margin.

• DISCOVERY HEALTH medical scheme remains on our monitoring system,

though it has increased its solvency to 23,62 % from 2,58% in 2002.

• MEDSHIELD has reached the required 25% solvency level but remains on mon-

itoring until concerns on high levels of non-healthcare expenditure are

resolved.

• RESOLUTION HEALTH’s solvency has also increased to almost 25% but the

scheme remains on the monitoring programme until concerns over gover-

nance and high non-health expenditure have been fully dealt with.

• FEDHEALTH, SPECTRAMED, BESTMED, SIZWE, BONITAS, MEDCOR and CSIR have all

reached the prescribed 25% solvency level in line with agreed business plans

and are no longer on our monthly monitoring programme.


2


● An Asen, of the Fonpeople of Benin, this

piece of “theatre” marksthe grave of, and is

offered to a dead personand is used in rituals tohonour that person. WilliamKentridge writes: “There isan initial understandingbetween the donor and thecraftsman; a briefing ofwhat is needed on the asen,or a list of requests fromthe donor to the maker…”

Reinsurance

The financial results of schemes show that the dramatic decline in reinsurance

losses has continued along with increases in solvency levels. Reinsurance

losses have decreased from R297 million in 2002 when the Act was

amended to require greater oversight of reinsurance, to R123

million in 2003 and now R7,8 million in the period under review.

Medical schemes auditor approvals

The process of auditor approval has been continued. We have again

refined the approval process, and have now been able to ensure that

a greater number of auditor approval applications are received and con-

sidered before the commencement of the statutory audit. This suggests

that Council’s auditor approval process is gaining in effectiveness and that

medical schemes and their auditors are paying increasing attention to legisla-

tive requirements in this regard.

Medical schemes’ financial performance during 2004

Part four of this annual report contains a comprehensive analysis of the financial

performance of medical schemes during 2004. A brief review of these financial

results shows the following points:

• During 2004, the number of principal members of medical schemes increased

by 1,1% to 2.8 million members. However the ratio of dependants to mem-

bers has continued a slight downward trend leaving overall beneficiaries figure

unchanged at 6,9 million for the year. The dependants ratio declined to 1,45

from 1,48 the previous period.

• The proportion of pensioner members (those 65 and over) within schemes has

grown to 6,7% from 6,4% in 2003.

• We have collected data for the first time on the provincial distribution of med-

ical scheme members. These data shows that 37,3% of members are-in

Gauteng, while 17,3% and 14,9% are in the Western Cape and KwaZulu-Natal,

respectively. The Northern Cape accounted for the least number of members

of medical schemes at 2,2%.

• Gross contribution income increased by 7,4% to R52,2bn. Risk contributions

were R46,7bn while medical savings accounts contributions were R5,5bn.

• Once again the industry’s financial picture is in good health. Net assets rose

35,4% to R20,4bn from R15,1bn the year before. Total surplus from opera-

tions has increased steadily since 2001, and rose 17,2% to R2,8 billion from

R2,4bn in 2003.

• The inclusion of investment and other income increases the overall surplus to

R5,0bn, an increase of 14,1% compared to 2003. Accumulated funds grew by

34,1% to R18,9bn from R14,1bn last year.

• The solvency ratio of the industry as a whole rose to 36,6% at December 2004

from 29,3% the previous year. Open schemes grew solvency by 33,5% to



2

● Divination items. These formpart of the set of items keptby a sangoma or traditionalhealer and used for diagnosingailments and prescribingremedies. Southern African

Wood, cowrie shells, ivory


27,9%. Restricted schemes, on the other hand, achieved a solvency position of

58% compared to 49,3% in 2003.

• The ability of medical schemes to pay claims has increased considerably over

the past three years. The number of months’ claims that schemes can cover

from their existing cash and cash equivalents have increased to 5,7 months

from 4,2 months in 2003.

• Total expenditure on benefits increased by 7,2% to R41.5bn. The increase per

beneficiary per month was 6,5%. Private hospital expenditure increased by

18,8% to R15,7bn. Spending on public hospitals increased by 5,3% to R261,9

million. Medical specialists accounted for R8,2bn, and increase of 8,4% on the

previous year, while expenditure on general practitioners declined by 1,7% to

R2,9bn. Expenditure on medicines, in a year that saw a great deal of activity


2


2000 01 02 03 04

Prescribed Solvency Level Industry Average Open

% Solvency ratio

10.00

13.50

17.50

22.00 25.00

13.30

13.5015.10

20.90

27.90

0

5

10

15

20

30

Figure 5: Solvency of open schemes

25

Figure 5: Solvency of open schemes

2000 01 02 03 04

10.0013.50

17.5022.00

25.00

34.2036.30

41.30

49.60

58.00

0

10

20

30

40

50

60

70

Prescribed Solvency Level Industry Average Restricted

% Solvency ratio

Figure 6: Solvency of restricted schemes

around pricing in the judicial arena, decreased to R8bn from R8,6bn in 2003.

• Administration expenses increased by 10,3% to R5bn and managed care

expenses rose by 12,6% to R1,3bn. These two components of non-healthcare

expenditure effectively accounted for 12% of gross contribution income

(11,7% in 2003).

• The increase in broker fees of 21,1% to R704 million continues to underscore

the problem of churning and inefficient utilisation of members’ contributions.

We intend to place firm new recommendations before the Minister in order to

deal with this matter.

• Bad debts, or “impaired receivables” amounted to R215 million in 2004, a

decrease of 33,2% on 2003.

• Total non-health expenditure rose by 7,6% to R7,1bn and accounted for

13,9% of gross contributions. Non-health expenditure per beneficiary has

increased in real terms by 6,5% to R893.

Accreditation of administrators and managed healthcare entities

A lengthy process on accreditation of administrators and managed healthcare

entities came close to finality in the course of 2004/05.

The Council has been working on proposals for an appropriate policy direc-

tion for the use of managed care by medical schemes. The initial phases of accred-

iting managed health care entities began during this period and coincided with

the development of these policy proposals.

Some 47 managed care entities were accredited during the period under review.

Many of these are subject to various conditions that must be complied with in

order to remain accredited. These included Clinical Partners (Pty) Ltd, a company

associated with the Netcare hospital group. During the year 2004/05, we asked the

Competition Commission for a view on whether or not this particular arrangement

of doctors associated with the hospital group, posed potential competition prob-

lems. The Commission responded that the issue could only be determined in the

light of the conduct and contractual arrangements by the proposed entity. Council

then decided to accredit the company as a managed healthcare organisation, sub-

ject once again to various conditions.

The need for accreditation means that the provision of managed healthcare

services will be illegal if organisations offering the service are not accredited as

providers. This process is intended to ensure that the provision of these services

enhances the quality and efficiency of services to beneficiaries of medical schemes.

The same would apply to the accreditation of administrators – existing admin-

istrators are deemed to be accredited until the process of evaluation has been com-

pleted. During 2004/05, some 11 applications for accreditation were scrutinised

and approved, subject to a number of conditions. This information has been

placed on our website.

This process will have implications for those providing administration servic-

es and charging for them but who have not applied for accreditation or whose

accreditation has been denied. Once again, these moves, required by statute, are



2

implemented to ensure that medical schemes and

their beneficiaries receive adequate service in the

administration of the funds intended for their

health care.

Accreditation of brokers

There were 6 684 individuals accredited as

health brokers during the year. We have also

accredited 152 new organizations and 211

had their accreditation renewed. There were 596

accredited broker organizations on our database.

Registration of rules, new schemes andassessment of amalgamations

An important development during this period was the registration in

November 2004 of the new Government Employees Medical Scheme (GEMS).

The registration was subject to several conditions and much of 2005 was to be

spent setting the scheme up with the involvement of the unions and other staff

representatives. Some 1,5 million members could be covered by GEMS by 2009.

Its appearance on the scene will have profound implications for several schemes

that currently have large numbers of civil service members.

The registration of scheme rules has proceeded apace. The process was slower

in the year under review partly because of difficulty by schemes in interpreting

properly the requirements for designated service providers, and partly because of

added scrutiny of benefit design by our team. One issue that has emerged as high-

ly complex has been the attempt to ascertain the quantum of co-payments for pre-

scribed minimum benefits in a setting that is not a designated service provider.

Some schemes have required co-payments in excess of 80% of the cost – which we

have had difficulty in approving. Nonetheless, attempts to quantify the exact

amounts in order to come to a reasonable co-payment quantum have been more

complex than originally contemplated.

Among the amalgamations considered during the year were those of Oxygen

and Meds; PULZ and NMP (to form Momentum Health); Discovery and

AngloGold and SAB and ABI. The request by IBM to amalgamate with DHMS was

turned down as we believed that this will not be in the best interests of many

members of IBM. The amalgamation of NMP and PULZ caused a great deal of

member confusion seemingly caused by inappropriate communication. This was

eventually sorted out with the help of our office.

Bargaining council medical schemes

Bargaining council medical schemes remain largely outside of the regulatory

ambit of the Medical Schemes Act. The regulatory concern here is that members


● Diviner’s necklace. Part ofthe regalia worn by a sangomaor traditional healer whenconsulting with and treatingclients.Swazi/Tsonga-Shangaan, SouthAfrica

Glass beads, thread, ndoro (conusshell)


2


covered by these schemes are not afforded the protections offered by the Act.

Nonetheless, there is recognition that several of these entities have devel-

oped an effective mechanism for the delivery of basic health care.

We undertook a project to evaluate options for the resolu-

tion of uncertainties over the migration of bargaining coun-

cil schemes to the Medical Schemes Act, as required by

legislation. A situational analysis of these schemes has

been undertaken, together with the Department of

Labour, to gain a broader understanding of these

schemes and the environment in which they operate.

The findings have been discussed in workshops with

bargaining councils around the country, and will lay

the basis for policy on these schemes.

Governance of medical schemes

Several events during the course of 2004/05 prompted the Council to devote con-

siderable resources to examining governance of medical schemes. One of our

“theme” projects focussed on governance, in particular on identifying the causes

of governance failure within schemes and recommending additional strategies to

improve governance and to mitigate the risk of governance failure. Several scheme

representatives, administrators and others gave their time and expertise to partic-

ipate in the investigation.

Some of the preliminary findings have been interesting and pointed to some

of the areas where attention could be devoted. For instance, although trustees of

many of the boards of trustees showed a great range and variability in skills and

experience, most schemes did not have a formal induction programme for new

trustees. Induction was usually informal. Although schemes saw it as their respon-

sibility to ensure that trustees were fit and proper to carry out their duties, few had

any screening processes to ensure that trustees were, indeed, fit and proper. This is

an area where the Act provides insufficient clarity. On remuneration of trustees,

widely-varying practices exist on boards of trustees. This can range from large

amounts for some trustees to small honoraria and some cases only certain trustees

might be paid while others receive no payment at all. Problems however, arise if

this information is not made properly available to scheme members for their

approval at annual general meetings. While schemes reported that members had

easy access to trustees, this survey did not approach members who frequently

report through the media that they do not have access to trustees. Despite the

obvious need for member participation and the creation of a system of gover-

nance demanding this, very few members participate through the annual general

meetings. Participation rate in the schemes surveyed ranged from 5% to 17% in

some closed schemes. In the examples outlined above, conflict of interest is often

a problem. In the survey, it became clear that some respondents had little or no

understanding of the concept. Most trustees and principal officers interviewed,

however, had a reasonable understanding of what would constitute conflict of



2

● Orikogbofo – a beaded crownof the Yoruba of Nigeria.

Constructed like an Engishbarrister’s wig, it would beworn by a potentate or kingwielding authority andintended, it would seem to beassociated with the Britishlegal system.. Yoruba wigs orcrowns frequently drew onBritish colonial images.

interest in the medical scheme setting. This report is still to be elaborated upon

before recommendations can be made and acted on.

Poor behaviour in governance of schemes inevitably has the result of forcing

costs up for medical scheme members while reducing the overall effectiveness of

the scheme. Problems have arisen in schemes that might be characterised, in

extreme cases, as corruption. In other cases, questionable judgement of trustees in

some of their actions has had to be dealt with at Council. In still other cases,

squabbles between trustee members of boards have rendered schemes literally

ungovernable, and have meant that members cannot be adequately serviced.

Some boards are constituted in such a way that the member is unable to have the

appropriate say in the scheme’s governance as set out in the Medical Schemes Act.

Council is able to take a certain amount of action when failures of governance

occur in schemes.

PROSANO

For much of the year under review, Council has been in talks with Prosano’s

trustees on the manner in which the Board of Trustees has been constituted.

Council believes the constitution of the scheme’s governance structures is incon-

sistent with the requirements of Section 57 of the Medical Schemes Act which pro-

vides for members to be able to elect a board of trustees. Prosano members are

able only to vote for regional structures but not for the main Board of Trustees.

These regional representatives then vote for the national board from their own

ranks. Two directives were issued by the Registrar to Prosano instructing the

scheme to change its rules so as to comply with the Act, and also to cease pay-

ments of honorariums and fees to people who are not members of the Board of

Trustees. Both directives were appealed by the scheme to Council, which eventu-

ally, in December, dismissed the appeal. The issue, however, has not been settled

and is now before the Appeal Board. It the meanwhile, disputes between various

scheme trustees continue as do differences between the board of trustees and the

Office of the Registrar.

HOSMED

Trustees of the scheme were “removed” from their position as trustees by members

at the scheme’s annual general meeting. Interim trustees were appointed to take

over the management of the scheme. Part of this dispute was manifest in legal

action before the High Court intended to resolve a dispute over which adminis-

tration company would administer the scheme.

The “interim trustees” then asked to meet with the Registrar, ostensibly to

“present their credentials” as lawful trustees of the scheme. Acting in accordance

with advice from senior counsel, the Registrar declined the meeting on the basis

that the application before the High Court would resolve the dispute regarding the

legitimacy of the two boards, and that the Registrar only had those powers fore-

shadowed in the Act and did not have the power to mediate the dispute between


2


the rival trustees.

The Registrar took the view that the lawful trustees of the scheme would be

decided by the High court, and that once that has been done the Registrar would

be in a position to act in terms of the Medical Schemes Act. Predictably perhaps,

the lawyers of the so-called “interim trustees” chose to view this response as evi-

dence of “bias” and “dereliction of duty” by the Registrar, for which they threat-

ened to take the issue to higher levels of decision-making to act on their behalf.

The Registrar joined the court action as a “friend of the court” to help the court

understand the issues involved. The judge found that the removal of the trustees

by the AGM was illegal and invalid, and that the appointment of the so-called

interim trustees was illegal and had no legal force. The judge further ordered that

all costs borne by the Registrar’s office in submitting affidavits “as a friend of the

court” should be repaid by the scheme.

COMMED

A similar disagreement occurred in Commed medical scheme between members

of the Board of Trustees following a vote of no confidence at a Special General

Meeting. A court order was eventually handed down, with three members from

each “faction” taking places on the Board of Trustees and a seventh trustee being

appointed by the Registrar. Despite this, the trustees were unable or unwilling to

come to some arrangement to keep the scheme running and decided to take their

issue to the High Court to seek a resolution to the impasse largely created by the

non-appearance of one faction at meetings causing the meetings to be without a

quorum. The High Court ordered all the trustees to attend the meetings, failing

which any meeting held by those who attended would be deemed to be quorate.

In the meanwhile, the Registrar has ordered a forensic audit of the scheme to look

into possible irregular payments.

PROTECTOR HEALTH

Protector Health medical scheme approached the Registrar to seek advice on the

possibility of declaring a breach of contract by its former administrator of the

same name. The scheme was advised that the Registrar’s office, having looked at

the situation, did not believe that there was a material breach of contract. The

trustees were also warned that they might, in all likelihood, expose the scheme to

a damages claim should they proceed to terminate the contract on the basis of the

alleged breaches. The scheme chose to ignore this advice, terminated the contract

and appointed another administrator. The scheme has subsequently lost an arbi-

tration case and has been told by the arbitrator that the termination was illegal

and that the old administrator would be entitled to damages for breach of the

contract. At the same time, we were concerned about the financial position of the

scheme and had difficulties relying on the accounts placed before us. An inspec-

tion was ordered into the scheme in order to understand better its financial posi-

tion. A plan to sort out the scheme’s position has followed.



2

RESOLUTION HEALTH

The trustees of this scheme purported to outsource the day-to-day

running of the scheme to a ‘management company’, whose directors

consisted of some of the trustees. The Board claimed that this

was not a conflict of interest but, rather, another model of gov-

ernance. This was not our view and we held a number of meet-

ings with the trustees to persuade them to change. Allied to

this new model was a substantial sum of money flowing to the

management company as management fees. The trustees have

now agreed to wind down this ‘management company’ to

ensure that the scheme is run by the Board of Trustees. We con-

tinue to keep a close watch on this matter.

SELFMED

We have questioned several issues concerning governance at

Selfmed, including the manner in which the scheme’s chairperson

ostensibly appointed himself the principal officer and CEO. Also

under scrutiny was the approximately R1 million level of remuneration awarded

to this part-time post and other dubious appointments of family members to the

scheme’s executive management. This matter has not yet been resolved.

MEDSHIELD

In the previous year, we reported that MAPP, a company supplying broking serv-

ices to the Medshield medical scheme, had challenged the Registrar’s capacity to

carry out an inspection of its premises in terms of the Medical Schemes Act and

the Inspection of Financial Institutions Act, alleging that sections of both Acts were

unconstitutional. The dispute had arisen from allegations of improper use of

members’ contributions. An interdict granted against the Registrar was due to

come to a full hearing in the period under review. Late last year, however, Mapp

decided to withdraw the legal challenges. It decided, too, to abandon the interdict

it had received against the office and agreed to pay R200 000 towards the

Registrar’s legal costs in this matter. Many of the issues that had concerned the

office have also been dealt with, and approximately R20 million has been paid

back into the scheme.

POLPRISMED

Action was taken to beef up governance at POLPRISMED by appointing a compli-

ance officer to assist with the governance of the scheme. A useful turnaround has

since occurred and the scheme ended the year in the black. The office has nonethe-

less pushed hard for the trustees to take some sensible long-term decisions on the

future of the scheme.


2


● Hakata (Divining dice). Theseform part of the set of itemskept by a ritual specialist andare used for divinationpurposes.Shona, Zimbabwe

Wood, bone


Continuing the enforcement of the demarcation line

The enforcements actions of the Council have included the cancellation of a

number of reinsurance contracts that were inconsistent with the Act.

Our focus on the demarcation between those products which do the business

of a medical scheme and which, therefore, have to register with the Council for

Medical Schemes and to comply with the Act, and those products which are insur-

ance products has fallen on the short-term insurance products. We are working

with the Financial Services Board to take the issue of compliance up with the

Short Term Insurance Association. At the same time, we are also preparing pros-

ecutions of some of these products.

Broker conduct – and misconduct

The absence of a code of conduct governing the behaviour of intermediaries sell-

ing medical schemes has provided for delays in disciplining brokers where com-

plaints against them have been laid and substantiated. However, during the year

two events have ensured that this can now proceed apace. The appointment in

terms of the Financial Advisors and Intermediary Services Act of an Ombud with

the power to resolve many of these problems and impose penalties on offenders

has taken place. With the Ombud’s appointment, a code of conduct is again in

use. We are in the process of organising a way of working with the Ombud to

ensure maximum effectiveness in sorting out problems the public faces when

dealing with complex products and potential mis-selling of them.

Inspections

Six inspections were undertaken during the year to assess the level of

compliance with the provisions of the law governing the payment of

commission to intermediaries. A trend appears to have emerged in

which a separate company or channel is set up as a “distribution channel”

which is paid separately from the intermediary service itself. This is an area

which deserves greater clarity to ensure that members of schemes are not

being made to pay for services which should, ordinarily, be provided by brokers

and paid for in the normal course of broker payments. In some cases it appears as

if the mechanism has been set up purely to enable larger payments to brokers and,

so, to avoid the provisions of the regulations in this regard.

Undesirable business practices

The undesirable business practice declaration in respect of the sale of the admin-

istration capacity of a scheme without fair valuation, a proper and transparent

process and to officers and employees of the scheme was finalised and gazetted.

This was generally very well received. In this regard, discussions with Munimed

with regard to the inappropriate alienation of its administration capacity were sat-

isfactorily completed. The medical scheme, the trust that was set up to hold the



2

● Goldweights Geometric andfigurative brass weights wereused in West Africa to weighgold dust and nuggets in theproduction and use of gold aspart of the gold tradingeconomy Ashante, Ghana

Goldweights

Brass


administrator “on behalf of the members” and the office of the Registrar agreed

that the administrator should be sold and the proceeds repatriated to the scheme.

A potential purchaser was being sought for the purpose.

The going has been less smooth between Medihelp and the Office of the

Registrar. Medihelp has been informed that we do not approve of its proposed sale

of its administration capacity to a consortium including the CEO of the scheme

and other officers of the scheme. The parties have been advised that such a sale

would contravene the undesirable business practice declaration. Medihelp subse-

quently appealed against the Registrar’s decision to the Council.

Trustee training

Trustee training remains an important component of Council’s compliance strat-

egy. Trustees rely heavily on the provision of training by the Council. A good deal

of time and effort was expended on training on governance, financial manage-

ment and clinical governance. During the course of the year, trustee training was

provided in several centres around the country each month. The training pro-

gramme has been developed, with the suggestions of participants, so that training

appropriate for those new to the medical schemes environment can be provided

at some sessions, and those with a more sophisticated understanding of the terri-

tory can develop their knowledge and understanding further. We have also includ-

ed in the training specific areas that trustee may find interesting and that can be

usefully delivered by experts in the field outside of the Council. This included the

help of the department of health’s pharmaceutical policy people when the medi-

cines pricing began to influence the workings of schemes and benefits design.

Our work with scheme beneficiaries and the public

Consumer education

The flipside of training trustees on suitable governance practices is the need to have

an informed and involved member body that can make its trustees accountable.

Our training has extended to trade union groups around the country whose

members participate in medical schemes. In addition, groups of consumers have

asked from time to time for the assistance of Council on specific areas in which

they need training and this, too, is given. A new area that has been developed has

been in the growing need for the human relations departments of various govern-

ment and local authority departments to acquaint themselves with the workings

of schemes, the Council and the law as it pertains to medical schemes, so that they

can better assist their staff members.

Flowing from this has been the development and co-operation within the

Regulators’ Forum of the consumer-training divisions of various regulators and

other statutory groups such as the provincial consumer departments dealing with


2


the Medical Schemes Act.

These aspects of our training schedule have been important and useful devel-

opments that hold out the promise that the reach of the Council can be extended

to assist members well beyond our current staffing constraints.

Resolving complaints raised by members against their schemes

A major function of the office of the Registrar is the resolution of complaints that

schemes have not resolved between themselves and their members or doctors.

Our complaints section received 2 456 complaints for the financial year 2004/5

of which 1 848 (76,16%) were found to have been valid.

Table 1 shows the classification of complaints received for the financial year

2004/5.



2

Type of complaint Number % of total 2003/04comparatives

UNPAID ACCOUNTS 660 35.71% 795

EXCLUSION OF BENEFITS 325 17.58% 236

NON PAYMENT OF REFUND 199 10.76% 199

MISUNDERSTANDING WITH SCHEME 131 7.08% 157

UNAUTHORIZED DEDUCTIONS 110 5.95% 104

TERMINATION OF MEMBERSHIP 101 5.46% 76

EXORBITANT PREMIUMS 63 3.40% 42

LOSS DUE TO BUREAUCRATIC INEFFICIENCIES 44 2.38% 73

REVERSAL OF PAYMENT 40 2.16% 33

REFUSAL BY SCHEME TO GIVE AUTHORIZATION 32 1.73% 43

PROBLEMS WITH GOVERNANCE STRUCTURE 20 1.08% 66

MEMBER FRAUDULENTLY ASSIGNED 19 1.028% 7

SUSPENSION OF MEMBERSHIP 17 0.91% 18

WITHHOLDING OF BENEFIT INFORMATION 15 0.81% 15

UNREASONABLE WAITING PERIODS 13 0.70% 8

LATE JOINER PENALTY 12 0.64% 12

CONCERN REGARDING MANAGEMENT OF SCHEME 12 0.64% 33

EXCLUSION OF PRE-EXISTING CONDITION 6 0.32% 4

PREMIUM INCREASE WITHOUT PROPER NOTICE 6 0.32% 6

REJECTION OF APPLICATION 6 0.32% 8

UNETHICAL MARKETING PRACTICES 6 0.32% 9

REFUSAL TO PROVIDE MEMBERSHIP CERTIFICATE 6 0.32% 2

RESTRICTION OF CHANGE OF OPTION 3 0.16% 2

RESTRICTION ON CHOICE OF PROVIDER 2 0.10% 2

TOTAL 1 848 100% 1 957

Table 1: Complaints received during 2004/05

We have resolved 1 682 of the 1 848 complaints found to have been valid. This

is 91% of the total number of valid complaints that have been received. Many of

the complaints that were not resolved related to lack of proper details and infor-

mation provided by complainants. We continue to deal with these in order to

ensure that they are finalised.

“Unpaid accounts” was the largest component, as it always is, of complaints,

comprising more than 36% of the total. The causes of the disputes in this area are

not simply the scheme as Goliath, pitted against the individual and powerless mem-

ber. Much of it appears to be due to a lack of understanding of complex products

and rules and the systems that have developed in individual schemes resulting, at

times, in a scheme refusing to pay an account in terms of its rules.

Some of these problems might relate to inappropriate marketing material – a

problem we hope to tackle in the coming year.

A few schemes have, it seems deliberately, chosen to ignore the legal requirement

for the provision of alternative medication to that in formularies or algorithms when

clinically necessary. But in some cases it appears, as well, that providers have not

acquainted themselves adequately with the provisions in the regulations so that they

may more properly assist their patients. This, too, has given rise to complaints.

Adjudication of appeals

The Council has a board sub-committee whose function is to hear appeals by

those aggrieved either by a decision made by their scheme’s disputes committee or

by the Registrar. Twenty appeals were heard during the year under review,.

An important case before the appeals sub-committee concerned the refusal by

Prosano to implement the Registrar’s directive on necessary amendments to the

rules of the scheme setting out its governance structure. Section 57(2) of the Act

requires that at least half of the members of a scheme’s board of trustees shall be

elected from amongst the members of the scheme. Prosano had contended that

the scheme’s rule in this regard were not inconsistent with this section.

In its decision, the appeals subcommittee found that the rules were, indeed, at

odds with the Act insofar as a majority of persons can feasibly be trustees in terms

of these rules without ever having been subject to an election by members of the

scheme. A further appeal has been heard by the Appeal Board which has upheld

the Registrar’s directive in its entirety.

During the course of last year, the Registrar declared certain practices to be undesirable

business practices. This effectively outlawed the practice of medical schemes which were self-

administered, hiving off their administration sections into a separate company, in which

employees/trustees of the scheme might have a financial interest and then selling the service

back to the scheme without a process of evaluating whether or not the disposal of the admin-

istration was done at fair value.

This declaration occurred at a point at which Medihelp Medical Scheme was

seeking to separate its administration from the rest of the scheme and to form an

administration company consisting of existing employees of the scheme. On 23

June 2004, we advised Medihelp that the proposed transfer of its administration


2


assets to a company called Strata would constitute an offence in that it would

result in a harmful business practice declaration, in that employees of Medihelp

would have a direct or indirect financial interest in Strata.

The issue came before the appeals sub-committee of the Council where

Medihelp argued that Strata would be formed and assets and liabilities of the

scheme would be transferred to the new company. Staff would then be transferred

to the new company, and only then would the scheme enter into an administra-

tion contract with the new company. On this basis, Medihelp argued that at the

time the administration contract was entered into, the persons who had an inter-

est in the new administration company would no longer be employees of the

scheme, and that the transaction would not be inconsistent with the undesirable

business practice declaration. In its decision, the appeals sub-committee rejected

this argument and upheld the Registrar’s decision that the proposed transaction

would constitute an undesirable business practice as envisaged in the declaration.

It was clearly demonstrated at the hearing that the transfer of employees could

not take place until an administration agreement had been entered into. Until

such time as the administration agreement was finalised, the employees would be

employees of Medihelp. This would ensure that they fell foul of the Registrar’s dec-

laration.

Another case before the appeals subcommittee concerned the refusal by

Discovery Health Medical Scheme to meet the costs of orthodontic treatment, the

removal of wisdom teeth and maxillo-facial surgery. The appellant, KK had joined

Discovery in the beginning of February 2003. He claimed that, during 2003, he

was covered for hospitalisation for the removal of wisdom teeth and for maxillo-

facial surgery, but that in 2004 he was informed that he was not covered for such

hospitalisation. He claimed that cover for such procedures was reinstated for

2005. In his documentation when he signed up there was an exclusion for a year

for maxillo-facial procedures among other conditions. This clause ensured that

Discovery would not have to pay for the procedure. Dismissing the appeal,

Council noted that, “In any event, even had his membership not been subject to

these exclusions, Discovery Health Medical Scheme would not have been obliged

to compensate the appellant. Upon joining Discovery Health, the appellant had

elected to join the coastal core plan. Provision is made in this plan for a medical

savings account and the member is required to choose whether or not he or she

wishes to have such an account. The appellant chose not to have a medical sav-

ings account.”

Mr YY at Munimed had a similar experience. He joined Munimed on 1 July

2003. At that point the benefit schedule applicable to his membership provided

for unlimited orthodontic treatment. But in January 2004 the scheme restructured

its benefits and imposed an annual limit of R2 000 on specialised dentistry

including orthodontics.

YY’s employer had directed that he could not move schemes till the following

year unless he changed his job. But the member had ongoing expenses for his

son’s orthodontics and found himself saddled with the expenses and an inade-

quate benefit.



2

He was not granted relief by the Appeal Board

as it found the scheme was entitled to change its

benefits. His problem of not being able to get out

of the scheme until the following year was

one between his employer and himself and

could not be addressed by the Council and

its appeal processes.

ZZ’s case however at the Appeal Board

proved more successful for the appellant.

ZZ had been severely assaulted in an attack

and, after a stay in hospital, knew that fur-

ther surgery and treatment would be

required. This would involve the recon-

struction of the jaw and the replacement of

missing teeth with prostheses.

The Classic Priority Plan of Discovery appeared

to hold out the prospect of this treatment being cov-

ered and this was contained, according to the appellant, in

a section of the option’s launch document dealing with major

surgery – with a specific reference to trauma-related surgery.

Discovery’s view was that there were several phases to the type of reconstruc-

tion surgery needed, and believed that only the first phase could be classified as

trauma-related. The rest would fall under specialised dentistry.

This meant that Discovery was not prepared to go beyond the bone augmen-

tation required in the first surgery,.

The complainant took issue with the decision and it was referred to the

scheme’s ex-gratia committee, which decided to approve most of the rest of sur-

gery – but not the cost of the dental implants and abutments. No reasons for this

were given.

The member then took the issue to the scheme’s disputes committee which

decided that the information in the document was misleading and that a reasonable

person would have believed all the surgery and follow-up treatment to be included.

The disputes committee also described Discovery’s documents as containing a grey

area and suggested that Discovery review its policy definition and exclusions to

make this clearer. It confirmed the ex-gratia decision – but this was still insufficient

for ZZ who appealed to the Council in terms of Section 48 of the Act.

The Council agreed that the scheme’s interpretation of the rules was correct –

that it should only apply to the trauma-related surgery – but since both the ex-gra-

tia committee and the disputes committee had agreed that an extra amount should

be paid – the question that faced the Council, was “how much”. The Council held

that no logical basis existed for the distinction made by the ex-gratia committee on

where it decided to cut off the funding, and ordered that the scheme should pay the

costs of the further surgery because of the misunderstanding the literature had cre-

ated and that the costs of the implants and abutments be included.

During this period, the High Court was asked to rule on a dispute between a


2


● Izindondo – a necklace of 12brass beads – symbolisedwealth and Zulu royal controlover many aspects of life suchas lobolo, agricultural labourof women and conferred socialstatus.

medical scheme and the Council’s Appeal Board. The dispute arose from the

desire of the Appeal Board to hear evidence from a witness in a dispute between

Profmed medical scheme and the estate of a deceased person whose membership

had previously been suspended by the scheme. Much of the legal argument

revolved around the differences between an appeal before the High Court and an

appeal to the Appeal Board in terms of the Medical Schemes Act. In the end, the

court upheld the Appeal Board’s right to hear evidence, unlike the procedure

when a court ruling is appealed. The scheme was ordered to pay costs as well.

Communication and other stakeholder relationships

Much of the media work was in response to public concern early in the year about

increases to scheme premiums. Further into the year a robust media debate was

conducted around the problems in medicine pricing particularly in respect of the

medical schemes environment.

We continue to respond to the media on a number of issues and to appear fre-

quently on the electronic media, including on issues such as the impact of the new

medicines pricing structure on medical schemes and their members.

One edition of CMS News was published during the year. Our internal

newsletter, Masihambisane, has continued to appear regularly and has served as a

useful tool for communicating with staff on internal issues relevant to us.

The people of the council and management of other resources

The work of CMS Active – realigning people processes with ourorganisational strategy

Performance management

The staff coalition, called CMS Active has continued our work on realigning our

business with a strategy for management of our human resources. A new perform-

ance-management system has been agreed and will come into effect during the

2005/06 financial year. The coalition has also begun discussions on a remunera-

tion strategy with the aim of proposing policy in this regard during the new year.

Improving skills and developing career paths

We have engaged in a number of training initiatives during this period. All sixty

members of staff were taken through a course on improving customer service. This

culminated in a charter on customer service adopted by Council. The key challenge

now is to ensure meticulous implementation of the charter. Other training initia-

tives have included performance evaluation, attendance at a number of conferences

and seminars and development of technical skills such as conducting skills audits,

effective business writing, advanced computing and managing public relations.



2

Employment equity

Our employment equity profile is shown in figures 7 and 8. The Council has set

up an Equity Forum in terms of the law and developed a plan to ensure that staff

development takes place in terms of the Equity Act and to the benefit of the

Council and its work.

We have conducted qualitative analyses of policies, procedures and practices

through internal surveys and staff focus group discussions, as well as quantitative

analyses of workforce profiles to identify specific areas that require our attention.

We have debated employment equity barriers caused either by the lack of a policy

or by a policy that may permit unfair discrimination.

Financial management and information technology

The management of Council’s financial resources continues to be an important

part of our work. We have ensured that we have complied fully with the require-

ments of the Public Finance Management Act during the year under review. Our

internal auditors, GOBODO, have continued to provide good service, and internal

audits were conducted in four divisions, including financial supervision, research

and monitoring, compliance and the legal units. Our risk management team has

continued to function, and has focused on the implementation of a fraud preven-

tion plan at Council. The Council’s audit committee met four times during the

year. Two new external members also joined the audit committee during this time.

Table 2 below summarises the Council’s income and expenditure for 2004/05.

Staff costs have, predictably perhaps, been our main item of expenditure, account-

ing for 60% of total spend.


2


0 5 10 15 20 25 30 35

African

SeniorWhite

MxColoured

Asian

African

MiddleWhite

MxColoured

Asian

African

NonWhite

ManagerialColoured

Asian

Managerial level by racial groupingFigure 7: Managerial level by racial grouping

0 5 10 15 20 25

Male

African

Female

Male

White

Female

Male

Asian

Female

Male

Coloured

Female

Racial representation by genderFigure 8: Racial and gender representation



2

Table 2: Our income and expenditure during 2004/05

Income and expenditure analysis for 2004/2005.Analysis of cash flows for the year ending march 2005

Income 29 967 786

Grant Received 584 863

Levies Received 24 818 101

Accreditation and Registration Fees 4 188 908

Other Income 375 914

Debtors -319 777

Cash Received from clients 29 648 009

Interest Received 716 110

TOTAL CASH RECEIVED 30 364 119

Expenditure 34 889 976

Administration 2 458 820

Appeal Board 316 698

Accreditation Costs 540 000

Audit Fees 296 029

Conferences and workshops 712 833

Consulting Fees 107 362

Consumer Education 185 915

Council Committees 675 430

Depreciation 1 164 225

HR Organisational Strategy 305 730

Investigation Costs 647 208

Legal costs 2 122 402

Media & Promotion 421 774

NRPL 562 287

Office Rental 1 713 087

Personnel 21 044 349

Research Costs 577 850

Resource Centre 126 017

Risk-Equalisation Project 584 863

Strengthening Dispute Resolution 99 000

Trustee Training 228 097

Depreciation written back -1 164 225

Creditors -2 766 302

Cash paid to Suppliers and Employees 30 959 449

Capital Expenditure 402 011

Computer Equipment and Software 358 223

Office Furniture & Equipment 21 730

Other Assets 22 058

TOTAL CASH PAID OUT 31 361 460

NET CASH DECREASE -997 341

The Resource Centre has seen to it that the manuals required in terms of the

Promotion of Access to Information Act (POATIA) have been updated and sent to

the Department of Justice. A report required by the South African Human Rights

Commission in accordance with mandatory requirements on our implementation

of POATIA in compliance with legislative provisions has been duly supplied.

Our Information Technology environment has continued to be fairly stable

during this period. New work has included the revamping of the statutory returns,

in order to enhance the return and to introduce changes made in the Accounting

and Auditing Guide for Medical Schemes. We also developed the shadow risk

equalisation fund return to allow schemes to submit consolidated data by chron-

ic disease, age and gender of beneficiaries. The IT work has also included moves to

a new financial management platform (Account mate), a newly-designed website

and further development of a number of our critical databases, including the com-

plaints management and accreditation databases. We also installed a comprehen-

sive call centre solution during the year.

Conclusion

This report is characterized by actions we have taken to deliver effectively on the

core responsibilities of the Council. I believe there have been a number of signif-

icant improvements on many fronts. I would like to thank trustees, administrators

and others we have worked with for contributing positively to improvements in

the operations of medical schemes. I would also like to thank the Minister, Dr

Manto Tshabalala-Msimang, for her assistance and counsel during the year. Our

Council members deserve much credit for their dedication and advice. I wish

those who are not returning great success in their future endeavours. Finally, I con-

gratulate our staff for their unstinting dedication to the work of the Council.

T. Patrick Masobe

August 2005


2


Brass rings, Katanga coppercrosses, izindondo and ndoros.Throughout Africa metalproducts were associated withsupernatural powers and werehighly valued, largely because oftheir durability and symbolicstatus. Brass rings and Katangacopper crosses were traded ascurrency items; izindondo (solidbrass beads) were symbolic ofroyal Zulu power in the 19thcentury, and ndoros (shells) wereused for trade, bridewealth andto display rank and wealth.Central and East Africa

Brass rings, currency crosses, ndoros(conus shells)

Zulu, South Africa izindondo (brassbead necklace)

Brass, shell, copper

Standard Bank Foundation Collectionof African Art - Housed at theUniversity of the Witwatersrand ArtGalleries

●



2


R E P O R T O F T H EA U D I T O R - G E N E R A L

3

REPORT OF THE AUDITOR-GENERAL TO PARLIAMENT ONTHE FINANCIAL STATEMENTS OF THE COUNCIL FORMEDICAL SCHEMES FOR THE YEAR ENDED 31 MARCH 2005

1. AUDIT ASSIGNMENT

The financial statements as set out on pages 39 to 49, for the period ended 31 March 2005, have been audited in

terms of section 188 of the Constitution of the Republic of South Africa, 1996 (Act No. 108 of 1996), read with sec-

tion 4 and 20 of the Public Audit Act, 2004 (Act No. 25 of 2004) and section 13(4) of the Medical Schemes Act, 1998

(Act No. 131 of 1998). These financial statements, the maintenance of effective control measures and compliance

with relevant laws and regulations are the responsibility of the Registrar. My responsibility is to express an opinion

on these financial statements, based on the audit.

2. NATURE AND SCOPE

The audit was conducted in accordance with Statements of South African Auditing Standards. Those standards

require that I plan and perform the audit to obtain reasonable assurance that the financial statements are free of

material misstatement.

An audit includes:

• examining, on a test basis, evidence supporting the amounts and disclosures in the financial statement,

• assessing the accounting principles used and significant estimates made by management, and

• evaluating the overall financial statement presentation.

Furthermore, an audit includes an examination, on a test basis, of evidence supporting compliance in all material

respects with the relevant laws and regulations which came to my attention and are applicable to financial matters.

I believe that the audit provides a reasonable basis for my opinion

3. AUDIT OPINION

In my opinion, the financial statements fairly present, in all material respects, the financial position of the Council

for Medical Schemes at 31 March 2005 and the results of its operations and cash

flows for the year ended, in accordance with the Statements of Generally Accepted

Accounting Practice and in the manner required by the Public Finance

Management Act, 1999 (Act No. 1 of 1999).

4. APPRECIATION

The assistance rendered by the staff of the Council for Medical Schemes during the

audit is sincerely appreciated.

A H Mullerfor Auditor-General

Pretoria31 July 2005



3



3

Balance sheetOF THE COUNCIL FOR MEDICAL SCHEMESAS AT 31 MARCH 2005

31/03/05 31/03/04Note R R

ASSETSNon-current assets 1 992 939 2 755 152

Property, plant & equipment 3 1 992 939 2 755 152

Current assets 9 841 291 10 518 855

Trade debtors and other receivables 5 725 120 405 343

Cash and cash equivalents 4 9 116 171 10 113 512

Total assets 11 834 230 13 274 007

FUNDS AND LIABILITIES

Administration funds 4 702 111 8 908 190

Accumulated funds 4 702 111 8 908 190

Current liabilities 7 132 119 4 365 817

Trade creditors and other payables 6 5 868 189 2 770 440

Provisions 6 1 263 930 1 595 377

Total funds and liabilities 11 834 230 13 274 007

Mr T Patrick Masobe

Registrar of Medical Schemes

Date: 31/5/2004



3

INCOME STATEMENTOF COUNCIL FOR MEDICAL SCHEMESFOR THE YEAR ENDED 31 MARCH 2005

31/03/05 31/03/04Note R R

Revenue 7 29 967 786 29 644 910

Expenditure 34 889 976 34 299 922

Administration 2 458 820 3 222 115

Appeal Board expenses 316 698 391 354

Accreditation costs 540 000 1 200 000

Audit fees: 10 296 029 469 997

Conference, workshops & seminars 712 833 635 215

Consulting fees 107 362 170 495

Consumer education 185 915 193 912

Council Committees 675 430 651 694

Depreciation 1 164 225 1 263 695

HR/Organisational Strategy 305 730 -

Investigation costs 647 208 620 135

Irregular expenditure - 506 195

Legal fees 2 122 402 1 713 462

Media & promotion 421 774 512 458

NRPL 562 287 -

Office rental 1 713 087 1 554 643

Personnel expenditure 21 044 349 18 895 662

Research costs 577 850 734 072

Resource centre 126 017 174 328

Risk Equalisation Project 9 584 863 1 125 386

Strengthening Dispute Resolution 99 000 -

Trustee training 228 097 265 104

Operating deficit for the year (4 922 190) (4 655 012)

Interest received 716 110 1 477 582

Net deficit (4 206 080) (3 177 430)

Statement of changes in equityFOR THE YEAR ENDED 31 MARCH 2005

31/03/05 31/03/04R R

Balance at 31/3/2004 8 908 191 12 085 620

Net deficit for the year (4 206 080) (3 177 430)

Balance at 31/03/ 2005 4 702 111 8 908 190

Cash flow statementOF COUNCIL FOR MEDICAL SCHEMES FOR THE YEAR ENDED 31 MARCH 2005

31/03/05 31/03/04Note R R

Cash flow from operating activities

Cash receipts from debtors 29 033 988 29 966 077

Cash receipts from Department of Health 584 863 1 125 386

Cash paid to suppliers and employees (30 930 290) (30 336 254)

Cash utilised in operations 8 (1 311 439) 755 209

Interest received 716 110 1 477 582

Net cash flows from operating activities (595 329) 2 232 791

Cash flows from investing activities

Purchase of fixed assets (402 012) (682 008)

Net increase(decrease) in cash and cash equivalents (997 341) 1 550 782

Cash and cash equivalents at the beginning of the year 10 113 512 8 562 730

Cash and cash equivalents at the end of the year 4 9 116 171 10 113 512



3

Notes to the financial statementsFOR THE YEAR ENDED 31 MARCH 2005

1. Legislation

1.1. The Council was established under the Medical Schemes Act, 1998 (Act No. 131 of 1998)

1.2. The Council is a listed entity under schedule 3 of the Public Finance Management Act, (Act No 1 of 1999).

1.3. The Council collects levies from schemes in terms of the Levies Act 2000 (Act No.58 of 2000)

2. Accounting Policies

The principal accounting policies adopted in the preparation of these financial statements are as set out below and

are consistent with those of the previous year:

2.1 Basis of preparation

The financial statements are prepared under the historical cost basis and are in accordance with and comply with the

South African Statements of Generally Accepted Accounting Practice.

2.2 Non current assets

All items of property plant and equipment are recognised at cost less accumulated depreciation. Depreciation is cal-

culated on the straight line method to write off each asset over their estimated useful lives as follows:

Computer equipment 25%

Computer software 33%

Office furniture and equipment 10%

Motor vehicle 20%

Other assets 10%

Repairs and maintenance are charged to the income statement during the financial period in which they are incurred.

Expenditure that increases the original value and useful lives of property plant and equipment items are classified as

assets and amortised over their useful lives on a straight line method.

Where the carrying amount of an asset is greater than its estimated recoverable amount, it is written down immedi-

ately to its recoverable amount.

Gains and losses on disposal are determined by comparing proceeds with the carrying amount and are included in

the operating profit during the period in which they accrue.



3

2.3 Trade debtors and other receivablesAccounts receivables are carried at original invoice less provision made for impairment in value of these receivables.Where

circumstances reveal doubtful recovery of amounts outstanding, a provision for impaired receivables is made and charged to

the income statement.

2.4 Trade creditors and other payablesTrade and other payables are recognised at cost, comprising original debt less principal payments and amortisations.

2.5 ProvisionsProvisions are recognised when there is a present legal or constructive obligation as a result of past events, it is probable that

an outflow of resources will be required to settle the obligation and a reliable estimate of the amount can be made.

2.6 RevenueThe main sources of revenue of the Council are listed below.

2.6.1 LeviesLevies are the amounts paid by medical schemes based on the number of members in a scheme during the financial period.

Levies are recognised on an accrual basis in accordance with the number of members in the medical scheme in the period

they fall due.

2.6.2 Accreditation feesAccreditation fees are fixed tariffs paid by brokers over two years.Accreditation fees are recognised in the financial period in

which services are rendered.

2.6.3 GrantsThe Council receives grants from government for specific projects. Grants are recognised in the financial period at their fair

value where there is reasonable assurance that the grant will be received and the Council will comply with the attached con-

ditions. Grants relating to future costs are deferred and recognised in the income statement over the period necessary to

match them with the costs for which they are intended to compensate.

2.6.4 Registration feesRegistration fees relate to the amounts paid by schemes to register or amend their rules. Registration fees are recognised in

the financial period that they fall due.

2.6.5 InterestInterest income comprises interest received on cash and cash equivalents, and that earned on overdue levies. Interest income

is recognised in the income statement for all interest bearing investments on an accrual basis using the effective yield based on

the actual amount. Interest on overdue levies is calculated at the rate determined by the South African Revenue Services.



3

2.7 Cash and cash equivalents

Cash and cash equivalents are carried on the balance sheet at cost for the purpose of the cash flow statement. Cash

and cash equivalents comprise cash on hand and deposits held in current and call accounts at the bank.

2.8 Financial instruments

(a) Accounting for financial instruments

Financial instruments carried on the balance sheet include cash and bank balances, investments, receivables and

trade creditors. The particular recognised methods adopted are disclosed in the individual policy statements associ-

ated with each item.

(b) Financial risk management

Financial risk factors:

The Council’s activities expose it to a limited degree of financial risks including interest rates and credit defaults.

Interest rate risk:

The Council’s income and operating cash flows are to a large extent independent of charges in the market interest

rates. The Council invests surplus cash on call accounts and its exposure to interest rate risk is limited by virtue of the

limited term that surplus cash is held on call.

Credit risk:

The Council is exposed to credit risk, which is the risk that a counterpart will be unable to pay accounts in full when

due. There is no significant concentration of credit risk due to a wide spread of debtors that owe amounts to the

Council.

Liquidity risk:

The Council is exposed to liquidity risk by virtue of having trade creditors at year end. Liquidity risk is managed by

maintaining sufficient balances on cash and cash equivalents.

2.9 Research costs

Research costs relate to work performed by the research unit. The objective of the unit is to monitor the impact of

the Medical Schemes Act,1998 (Act No. 131 of 1998), research developments and recommend policy options to

improve regulatory environment. Research expenditure is recognised as an expense in the financial period in which

it was incurred.



3

Notes to the financial statements continued

3. Property, plant and equipment

Computer Computer Furniture Motor Other TOTAL

Equipment Software & Fitting Vehicle Assets fittings

Period ended 31 March 2004

Opening gross carrying amount 1 142 326 976 509 1 077 193 33 295 107 516 3 336 839

Additions 204 122 388 125 81 761 - 8 000 682 008

Depreciation charge (675 374) (415 468) (140 968) (14 269) (17 616) (1 263 695)

Closing net carrying amount 671 074 949 166 1 017 986 19 026 97 900 2 755 152

At 31 March 2004

Gross carrying amount 1 346 607 1 364 634 1 158 954 33 295 115 357 4 018 847

Accumulated depreciation 675 374 415 468 140 968 14 269 17 616 1 263 695

671 233 949 166 1 017 986 19 026 97 741 2 755 152

Year ended March 2005

Opening gross carrying amount 671 233 949 166 1 017 986 19 026 97 741 2 755 152

Additions 273 764 84 459 21 730 - 22 058 402 011

Depreciation charge (371 571) (615 019) (145 489) (14 268) (17 877) (1 164 224)

Closing net carrying amount 573 426 418 606 894 227 4 758 101 922 1 992 939

At 31 March 2005

Gross carrying amount 944 997 1 033 625 1 039 716 19 026 119 799 3 157 163

Accumulated depreciation 371 571 615 019 145 489 14 268 17 877 1 164 224

Net carrying amount 573 426 418 606 894 227 4 758 101 922 1 992 939

4. Cash and cash equivalents

31/03/05 31/03/04Note R R

Cash and bank 4 066 171 5 113 512

Call account 5 050 000 5 000 000

9 116 171 10 113 512

The effective interest rate on call account deposit was 7.35% (March 05: 7%) and these deposits have an average

maturity of 30 days.



3

5. Trade debtors and other receivables

31/03/05 31/03/04Note R R

Accounts receivable 173 673 126 705

Provisions for Impaired Receivables (29 158) -

Sundry debtors 580 605 125 758

Prepaid expenses - 152 880

725 120 405 343

6. Trade creditors, other payables and provisions

Accounts payable 1 835 552 1 168 535

Income Received In advance 4 032 637 1 601 905

Grant received in advance 3 762 751

Broker fees received in advance 269 886

Accruals 557 741 -

Provisions

Leave days 438 238 428 901

Accreditation Costs 267 951 1 166 476

7 132 119 4 365 817

7. Revenue

Accreditation fees 3 731 281 4 656 641

Appeal fees 9 091 10 526

Grant 584 863 1 125 386

Interest on levies 1 031 15 515

Levies 24 818 101 23 125 516

Other income 365 792 526 575

Registration fees 457 627 184 751

29 967 786 29 644 910



3




3

8. Reconciliation between net surplus and cash applied to activities

31/03/05 31/03/04Note R R

31/03/05 31/03/04

R R

Operating surplus/(deficit) (4 206 080) (3 177 430)

Adjusted for:

Depreciation 1 164 225 1 263 695

Interest received (716 110) (1 477 582)

Operating surplus before working capital (3 757 965) (3 391 317)

Decrease(Increase) in accounts receivable (319 777) 1 446 551

(Decrease)/Increase in accounts payable 3 097 749 1 983 905

(Decrease)/Increase in provisions (331 447) 716 070

(1 311 440) 755 209

9. Risk Equalisation Fund

During the year the National Department of Health (NDoH) granted Council an amount of R2 800,000 in respect

of the Risk Equalisation Fund Project. An amount of R584,863 was utilised during the year. The unutilised balance

at 31 March 2005 has been deferred and included as income received in advance.

Deferred grant income at the beginning of the year 1 547 614 -

Grant received during the year 2 800 000 2 673 000

Utilised in project activities (584 863) (1 125 386)

Utilised to defer depreciation charge relating to assets acquired - -

Deferred grant income at the end of the year 3 762 751 1 547 614

10. Audit fees

External audit 181 029 189 052

Internal audit 115 000 280 945

296 029 469 997

The external audit work is conducted by the Office of the Auditor-General

11. Going concern

The financial position of the Council is such that the Accounting Authority is of the view that its operations will con-

tinue for as long as its mandate remains.

12. Taxation

No provision for taxation is made because the Council is exempt from income tax in terms of section 10(1) (cA). of

the Income Tax Act, 1962 (Act No: 58 of 1962)

13. Related party transactions

Council members appointed by the Minister of Health, control the financial and operating activities of the Council.

Council members appoint the executive management which is responsible for executing Council member decisions.

The emolument paid to Council members and executive management is shown below:

31 March 2005Council members Fees for Basic Bonuses Expense Consulting Total

services salary allowances Fees

GN Padayachee 18 882 _ _ _ _ 18 882

NNA Matyumza 17 782 _ _ _ _ 17 782

R.L Morar 39 045 _ _ _ _ 39 045

N Mgumane 14 870 _ _ _ _ 14 870

JW Jekwa 46 812 _ _ _ _ 46 812

HD Mcleod 27 536 _ _ _ 380 331 407 867

S. Kariem 13 139 _ _ _ _ 13 139

J. Murphy 6 215 _ _ _ _ 6 215

BB Crookes 21 747 _ _ _ _ 21 747

206 027 _ _ _ 380 331 586 358

Prof.Heather Mcleod who is a Council member was appointed to assist the Risk Equalisation Project task team by

the Director-General of the National Department of Health. An amount of R2, 800, 000 was transfered by NDOH

for the project and her consulting fees are paid from this grant.(refer Note 10)



3


Executive management Fees for Basic Bonuses Expense Consulting Totalservices salary allowances Fees

_

TP. Masobe _ 675 805 143 816 12 000 _ 831 621

FFT Mothobi _ 552 167 109 099 18 000 _ 679 266

CJ Burton-Durham _ 497 411 82 216 18 000 _ 597 627

DG Kolver _ 473 243 78 479 18 000 _ 569 722

PR Sidley _ 446 694 74 100 18 000 _ 538 794

EE Theys _ 497 411 82 216 18 000 _ 597 627

KP. Matshidze _ 451 836 78 480 18 000 _ 548 316

_ 3 594 567 648 406 120 000 _ 4 362 973

31 March 2004

Council members 235 975 _ _ _ 481 679 717 654

Executive management _ 3 424 926 666 491 120 000 _ 4 211 417 4 997 908

235 975 3 424 926 666 491 120 000 481 679 4 929 071

The executive management are eligible for an annual performance-related bonus payment linked to the operational plans and

and strategic objectives of Council.The structure of the individual bonus plan and awards is decided by the Remunerations

Committee

of Council.

14. Contingent liabilities

At 31 March 2005 Council had a contingent liability of R408,584 arising from a legal claim by a former employee

for unfair dismissal.

Based on legal opinion, Council does not expect this liability to crystallise.

15. Operating lease commitments

Council has an operating lease for rental of the office up to 31 May 2010

The rental escalates by 7% compounded every year

Not later than one year 2 703 759 1 554 643

Later than one year and not later than 5 years 14 030 037 326 143

TOTAL 16 733 796 1 880 786



3

Report of the audit committee

We are pleased to present our report to the Council’s Accounting Authority for the financial year ended 31 March 2005.

Audit committee members and attendance

Please note that the term of audit committee members ended in August 2004. The committee consisted of the fol-

lowing members:

Meetings

Meetings and attendance for the year under review:

Name of Member Role Number of Meetings Attended

Mr. C. Mannya (Chairperson) 2

Mr. S. Patterson Member 2

Mr. O Thenga Member 1

Dr. R. Morar Member 2

Ms. G. Matyumza Member 2

The new audit committee, which commenced its new role from September 2004, consists of the members listed here-

under and meets 4 times per annum as per its approved terms of reference.

The committee held four (4) scheduled meetings and no special meeting was called during the year under review.

During these meetings the committee considered a number of issues including those discussed in the paragraphs below.

Meetings and attendance for the year under review:

Name of Member Role Number of Meetings Attended

Mr. Ronald Moyo (Chairperson) 4

Mr. Alex Hill Member 4

Dr. Reno Morar Member 4

Ms. Gando Matyumza Member 4

Other invitees.

Representatives of the Auditor-General, internal auditors and senior management attend these meetings as and when

requested to do so.

Audit committee responsibilities

Mandate

The mandate of the audit committee is derived from Section 38 (1) (a) of the Public Finance Management Act

(PFMA), and paragraph 3.1 of the Treasury Regulations.

The audit committee reports that it has complied with its responsibilities arising from section 38(1) (a) of the

PFMA and Treasury Regulation 3.1.13.



3

The audit committee also reports that it has adopted appropriate formal terms of reference as its audit commit-

tee charter, has regulated its affairs in compliance with this charter and has discharged all its responsibilities as con-

tained therein.

The effectiveness of internal control

The performance of an effective internal audit function is central to the proper operation of the audit committee. As

part of the Council’s governance structures, the audit committee has amongst others, an oversight function of ensur-

ing that the Council’s internal control policies, practices and procedures are in place, effective and adequate to safe-

guard the Council’s resources and achieve its mission. Establishing effective internal controls involves an assessment

of the risks the Council faces both from internal and external sources.

The system of internal control is effective, as the various reports of the internal and external auditors have shown.

The fraud and risk prevention plans have been developed by our internal auditors.

Review of legal cases pending at financial year-end

The committee reviewed legal cases against the Council that were pending at the financial year-end so as to assess the

adequate disclosure required in terms of GAAP and Treasury Regulations.

Evaluation of financial statements

The audit committee has reviewed and discussed the annual financial statements to be included in the annual report

with the Auditor General and the Accounting Officer. The committee concurs with the conclusions of the Auditor

General and hereby recommend the financial statements for adoption by the Council in terms of the PFMA.

Our commitment

The audit committee remains committed to working together with the Council and all stakeholders to promote

sound corporate governance and to strengthen internal control procedures in the Council.

Ronald Moyo

Chairperson of the audit committee

Date 22/7/2005



3



3

Review of operationsof medical schemes

Coverage by medical schemes

Number of medical schemes

Table 3 shows that there were 133 registered medical schemes operating during

2004. Forty eight (48) were open while 85 were restricted medical schemes. There

were also 12 bargaining council schemes in operation during the same period.

The number of medical scheme declined to 145 from 147 in 2004. The num-

ber of open schemes remained unchanged while that of restricted schemes

declined to 85 from 87. This reduction is attributable to liquidations, amalgama-

tions and mergers between schemes.


R E V I E W O FO P E R A T I O N S

4

TYPE OF SCHEME*

Size of medical scheme Open Restricted Bargaining Council Consolidated

Small (<6,000 members) 14 (16) 57 (58) 7 (7) 78 (81)

Medium (>6,000 members but <30,000 beneficiaries) 8 (5) 15 (16) 2 (2) 25 (23)

Large (30,000 or more beneficiaries) 26 (27) 13 (13) 3 (3) 42 (43)

Total 48 (48) 85 (87) 12 (12) 145 (147)

Table 3: Distribution of medical scheme by size and type of scheme

* Figures in brackets represent restated number of schemes in 2003

Membership of medical schemes

Table 4 shows that the total number of principal members of medical schemes

increased by 1,1% to 2 833 322 during 2004. Membership of open schemes

increased by 2,2%, while that of restricted schemes declined by 1,5%.

Membership of bargaining council schemes increased by 2,0% to 117 058 mem-

bers.

The number of dependants decreased by 1,0%. As a result the number of ben-



4

Table 4: Distribution of beneficiaries in medical schemes

Scheme type 2004 2003 % change

Registered Members 2 716 264 2 688 055 1,05

Beneficiaries 6 662 563 6 671 801 -0,14

Open Members 1 924 343 1 883 728 2,16

Beneficiaries 4 755 303 4 718 797 0,77

Restricted Members 791 921 804 327 -1,54

Beneficiaries 1 907 260 1 953 004 -2,34

Bargaining council Members 117 058 114 760 2,00

Consolidated Members 2 833 322 2 802 815 1,09

Beneficiaries 6 915 666 6 924 686 -0,13

Age distribution of beneficiaries

Figure 9 shows the age distribution of the medical scheme

beneficiaries during 2003 and 2004. There were more benefi-

ciaries aged between the intervals 5 and 15 years, 34 and 40

years and also those over 70 years during 2004. This reflects

a slight aging of membership of schemes with the average age

of medical scheme beneficiaries increasing to 32,0 years in

2004 from 31,9 years in 2003. The average age of members of

restricted medical schemes was 32,6 years, while that of open

schemes was 32,1 years.

Female members were generally older than males in all

medical schemes. The average age of male members was 31,4

years compared to that of female members at 32,6 years. The

average age of males in open schemes was 31,4 years while

that of restricted schemes was 32,0 years. Among females, the

average age in open schemes was 32,8 years while that of

restricted schemes was 33,2 years.

eficiaries declined by 0,1% to 6 915 666 from 6 924 686 in 2003. The number of

dependants in restricted schemes declined by 2,9% while in open schemes there

was a small decline in the number of dependants. Restricted schemes experienced

a drop of 2,3% in the number of beneficiaries while a marginal increase (0,8%)

was experienced in open medical schemes.

1<

1-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75+

2003 2004

No. of beneficiaries Thousands

0 100 200 300 400 500 600 700 800

Figure 9: Age distribution of medical scheme beneficiaries



4

Trends in membership

Figure 10 shows the trends in the number of ben-

eficiaries of all medical schemes over the last ten

years. The trend analysis shows that the number of

beneficiaries has remained fairly steady at around

7 million since 1996. It is noticeable that while

the number of members seem to have increased

steadily overtime, the number of dependants has

however been declining since 1999.

Pensioner ratio

The percentage of pensioners (beneficiaries who were 65 years or older as at 31

December 2004), increased to 6,7% from 6,4% in 2004. The percentage was high-

er in restricted schemes (7,8%) than in open schemes (6,3%), continuing a trend

that was observed in previous years.

There were proportionately more female than male pensioners in registered

schemes. Bargaining Council medical schemes were different in that they had a

higher proportion of male pensioners than females.

0

1

2

3

4

5

6

7

8Millions

95 96 97 98 99 2000 01 02 03 04

Members Dependants

Figure 10: Trend analysis of coverage of beneficiaries

Table 5: Pensioner ratio (>65 years) of registered schemes

Type of scheme Gender 2004 2003

Open male 6,00 6,40

female 6,62 5,40

consolidated 6,31 5,90

Restricted male 6,94 8,80

female 8,69 6,60


Registered schemes male 6,28 7,60

female 7,20 6,00


Bargaining Council* male 7,72 3,20

female 0,96 0,50


Consolidated male 6,33 7,00

female 6,98 5,80


* The 2004 results could be an indication of better reporting by bargaining council schemes.

Membership by province

Table 7 shows the provincial breakdown of membership

of medical schemes. These data were collected primarily

on the basis of the location of principal members. More than one third (37,3%) of

the beneficiaries of schemes are based in Gauteng, 17,3% are in the Western Cape

and 14,9% are in Kwazulu-Natal. The Northern Cape has the least proportion of

medical scheme members at 2,2%.

Dependants ratio

The dependant ratio, which measures the average number of dependants per prin-

cipal member of a medical scheme, declined by 2,0% to 1,44 from 1,47 in 2003.

The decline in the dependants ratio was highest in bar-

gaining council schemes followed by open schemes.

Restricted schemes on the other hand experienced the

least decline in the dependants’ ratio.



4

Province Members Dependants Beneficiaries % of total beneficiaries

Gauteng 1 092 200 1 487 204 2 579 404 37,30

Limpopo 98 047 181 611 279 658 4,04

Mpumalanga 166 418 287 790 454 208 6,57

North West 124 799 188 131 312 930 4,52

Free State 130 568 188 254 318 822 4,61

KwaZulu Natal 417 706 610 894 1 028 600 14,87

Western Cape 508 585 685 300 1 193 885 17,26

Eastern Cape 234 735 361 091 595 826 8,62

Northern Cape 60 264 92 069 152 333 2,20

Consolidated 2 833 322 4 082 344 6 915 666 100

Benefits

Total benefits paid by medical schemes

Expenditure by medical schemes on health care benefits increased to R41,5bn in

2004, an increase of 7,2% on 2003. This represents an increase per beneficiary per

month of 6,5% during 2004.

Figure 11 shows the proportions of benefits paid to hospitals, general practi-

tioners, specialists and others. Hospital expenditure, which includes theatre fees,

ward fees, consumables, medicines dispensed and global and per diem arrange-

Table 6: Dependant ratio in medical schemes

Type of scheme 2004 2003 % change

Registered scheme 1,45 1,48 -2,03

open 1,47 1,51 -2,65

restricted 1,41 1,43 -1,40

Bargaining Council 1,16 1,20 -3,33

Consolidated 1,44 1,47 -2,04

Table 7: Medical scheme membership by province

ments, accounted for 38,0% (R15,7bn) of the R41,5bn paid to providers. This is

an 18,5% increase on 2003. The increase in expenditure on private hospitals was

19,5% while that of provincial hospitals was 5,3%. Provincial hospitals account-

ed for 1,7% of the overall benefits paid to

hospitals.

In the private hospitals, ward fees account-

ed for 43,8% of the total private hospital

expenditure (includes global and/or per diem

arrangements), theatre fees made up 24,8%,

consumables were at 12,9% and medicines

dispensed within hospitals accounted for

18,5%.

Expenditure in the provincial hospitals was

dominated by ward fees which accounted for

75,3% of the total expenditure, consumables

made up 12,9%, while theatre fees and medi-

cines dispensed made up 6,7% and 5,1% respectively.

Medical specialists accounted for 19,9% of the total expenditure in 2004.

Expenditure on general practitioners declined by 1,7% to R2,9bn in 2004 from

R3,0bn in 2003.

Medicines dispensed by pharmacists and providers other than hospitals,

accounted for 19,2% (R7,96bn) of the total benefits paid by medical schemes.

Expenditure on pharmacists accounted for 82,9% of the total medicine expendi-

ture while dispensing practitioners accounted for 16,8%.

Allied health professionals accounted for only 0,3% of the total expenditure on

medicines. Expenditure on allied health professionals of increased by 2,4% to

R2,74bn in 2004 from R2,67bn in 2003.



4

Total Hospitals 38,0%

Medicines 19,2%

Allied and SupportHealth Professionals 6,6%Ex-Gratia Payments 0,1%Other benefits 2,4%Capitated Primary Care 2,1%

General Practitioners 7,0%

Medical Specialists 19,9%

Dentists 4,1%Dental Specialists 0,7%

Figure 11: Total benefits paid during 2004

Benefits paid out of risk pool

Benefits paid out of the risk pool amounted to

R36,8bn (88,9%) of total benefits in 2004; an

increase of 6,8% from R34,5bn in 2003.

Hospitals (private and provincial) accounted

for 42,6% of the total risk benefits paid in

2004 compared with 38,3% in 2003.

Medicines expenditure accounted for 17,3%

while specialists accounted for 19,9%.

General practitioners accounted for 5,9% of

the total risk benefits; a drop of 7,8% to

R2,2bn in 2004 from R2,4bn in 2003.

Total Hospitals 42,6%

Medicines 17,3%

Allied and SupportHealth Professionals 5,3%Ex-Gratia Payments 0,1%Other benefits 2,6%Capitated Primary Care 2,4%

General Practitioners 5,9%

Medical Specialists 19,9%

Dentists 3,3%Dental Specialists 0,6%

Figure 12: Benefits paid from risk pool during 2004

Trends in total benefits paid

Figure 14 shows the distribution of benefits to different types of providers since 1995.

The largest increase in expenditure was on hospitals, which rose by an adjusted

16,9% to R15,7bn from R13,5bn in 2003. Expenditure in private hospitals

increased by 17,2% to R15,5bn from R13,2bn in 2003. Provincial hospitals

increased their share by 3,8% to R248,8m from R252,3m in 2003.

In private hospitals, theatre fees increased by 35,9%, ward fees by 20,3% and

medicines dispensed in hospitals by 16,3%. Consumables declined by 8,8%. In

provincial hospitals, ward fees increased by 18,8%, and consumables by 2%.

Benefits paid from medical savings accounts

Personal medical savings accounts, which are accounts set aside by a medical

scheme for individual use by members and their dependants, accounted for

11,2% (R4,6bn) of the overall expenditure on

benefits. This reflected an increase of 10,7% on

2003. Medicines accounted for 34,0% of bene-

fits paid while medical specialists and general

practitioners accounted for 19,3% and 15,6%

respectively.

A small percentage (1,5%) of medical savings

accounts money was spent on hospital services

(1,5%); this reflects a 12,3% decline from

R80,7m in 2003 to R70,8m in 2004.



4

Dental Specialists 1,9%Total Hospitals 1,5%

Medicines 34,0%

Allied and SupportHealth Professionals 16,6%

Ex-Gratia Payments 0,0%

Other benefits 1,0%Capitated Primary Care 0,0%General Practitioners 15,5%Medical Specialists 19,3%

Dentists 10,1%

Figure 13: Benefits paid from saving accounts in 2004

01

3

5

7

9

11

13

15

17

Rand Billion

95 96 97 98 99 2000 01 02 03 04

❚ General Practitioners

❚ Medical Specialists

❚ Dentists (incl specialists)

❚ Medicines

❚ Private Hospitals

❚ Total Hospitals

❚ Ex-Gratia Payments

❚ Provincial Hospitals

❚ Other benefits

❚ Allied and SupportHealth Professionals

❚ Capitated Primary Care

Figure 14: Total benefits paid, 2004 prices

0

20

40

60

80

100

120

140

160

180

200

Rand PBPM

95 96 97 98 99 2000 01 02 03 04

❚ General Practitioners

❚ Medical Specialists

❚ Dentists (incl specialists)

❚ Medicines

❚ Private Hospitals

❚ Total Hospitals

❚ Ex-Gratia Payments

❚ Provincial Hospitals

❚ Other benefits

❚ Allied and SupportHealth Professionals

❚ Capitated Primary Care

Theatre fees and medicines dispensed in hospitals declined by 27,5% and 50,3%

respectively.

Expenditure on medical specialists increased by 6,9% to R8,2bn from R7,7bn

in 2003. General practitioners expenditure, on the other hand, declined by 3,1%

to R2,9bn from R3bn in 2003. Expenditure on medicines declined by 8,9% to

R8bn from R8,7bn in 2003. A similar trend was noted on dentists, including den-

tal specialists were expenditure declined by 5,2% to R2bn from R2,1bn in 2003.

There was a significant increase in expenditure on capitated primary care in which

rose by 106,1% to R886,4m from R430m in 2003. Expenditure on allied and sup-

port health professionals increased marginally by 1,0% from R2,7bn in 2003.



4

Total benefits paid per beneficiary

Figure 15 shows the overall increase per beneficiary in expenditure. Expenditure on

hospitals increased by 17,1% to R189,7 per beneficiary per month from R162,1 in

2003. The increase in private hospitals was 17,3% while that of provincial hospi-

tals was comparatively lower at 4,0%.

Expenditure on medical specialists increased by 7,0% to R99,3 from R92,8 in

2003. General practitioners’ share of expenditure declined by 3,0% to R35 from

R36,1 in 2003. A similar trend was noted among dentists and dental specialists

where expenditure declined by 5,1% to R23,9 from R25,2 in 2003.

Expenditure on medicines, when adjusted for inflation and membership,

declined by 8,8% to R95,9 from R105,2 in 2003. The most significant increase in

per beneficiary expenditure was that of capitated primary care which rose by

106,4% to R10,7 from R5,2 in 2003. Expenditure on allied and health profession-

als increased marginally by 1,1% to R33,0 from R32,6 in 2003.

Figure 15: Total benefits paid per beneficiary per annum, 2004 prices

Average utilisation of services

The average number of visits to a general practitioner per beneficiary was 3,3 in

2004; a slight decline from 3,4 in 2003. The visits were higher for restricted

schemes (3,9 visits per annum) compared to open schemes (3,0 visits per annum).

The average length of stay in private hospitals was 1,1 in 2004. This was high-

er for restricted schemes (2,4 days per annum) compared to open schemes (0,5

days per annum). The length of stay in provincial hospital was lower (0,1) than in

private hospitals.

The utilisation levels of primary healthcare services in registered schemes, particu-

larly general practitioners, declined from an average of 803,8 per 1000 beneficiar-

ies in 2003 to 740,5 per 1000 beneficiaries in 2004.

Admissions to both public and private hospitals were also lower than in the

previous year. Private hospital admissions declined to 197,9 per 1000 beneficiar-

ies from 243,5 in 2003. Public hospital admission declined to 11,5 admissions per

1000 beneficiaries from 24,1 in 2003. On the whole, utilisation levels were high-

er in restricted than open schemes, particularly for primary care services and

admissions to hospitals.



4

Utilisation of health services

Provider group Open Restricted Consolidated Consolidatedschemes schemes 2004 2003

per 1000 Beneficiaries

PRIVATE PROVIDERS

Number of beneficiaries visiting a GP at least once a year 710,99 811,31 740,46 803,76

Number of beneficiaries visiting a dentist at least once a year 260,65 335,59 282,66 301,02

Number of beneficiaries visiting a private nurse at least once a year 4,91 8,15 5,87 9,63

PRIVATE FACILITIES

Number of admissions to hospitals 190,43 216,04 197,95 243,49

PUBLIC FACILITIES

Number of admissions to hospitals 9,23 17,09 11,54 24,31

Table 8: Utilisation of services

Table 9: Average utilisation of services

Average utilisation Open Restricted Consolidatedof services schemes schemes 2004 2003

Visits to a general practitioner per year 3,03 3,93 3,30 3,44

Visits to a dentist per year 0,54 0,63 0,57 0,67

Visits to a private nurse per year 0,01 0,03 0,02 –

Length of stay in private hospital – 2,36 1,06 –

Length of stay in provincial hospitals – 0,06 0,05 –

Generally, the prevalence of chronic conditions in registered schemes was high-

er in restricted than in open medical schemes. The higher prevalence in restricted

schemes may be related to the higher age profile of these schemes compared with

that of open schemes.

Contributions, claims and trends during 2004

Total contributions and claims during 2004

Total contributions for all schemes increased on average by 7,4% to R52,2 bn from

R48,6bn in 2003. Total gross claims incurred went up 7,0% to R41,4bn from

R38,7bn in 2003. Gross contributions attributable to registered schemes only

(excluding bargaining council schemes) grew by 7,1% per beneficiary per month to

R645 from R602 in 2003, while gross claims per beneficiary per month jumped 6,7%

to R511 from R479.

In general, there has been a decline in the level

of utilisation of services of medical specialists

and allied health professionals. There was

however a noticeable increase in the level of

utilization of other benefits such as appli-

ances, prostheses and ambulance services

(Annexure G).

Burden of disease

A new set of 25 legislated chronic conditions

was introduced in the medical schemes envi-

ronment in January 2004. The regulations

required that these 25 prescribed chronic con-

ditions should be covered in all medical

schemes benefit options. Figure 16 shows the

prevalence of these chronic conditions. The

data represents 77,4% of schemes and 76,7%

of beneficiaries. Schemes that did not submit

any data on chronic conditions were excluded

from the analysis as were schemes that sub-

mitted poor quality data. The analysis showed

that the most prevalent condition in medical

schemes is hypertension (91 cases/1000 bene-

ficiaries), followed by hyperlipidaemia (34 cases/1000 beneficiaries) and asthma

(25 cases/1000) beneficiaries.



4

Hypertension

Hyperlipidaemia

Asthma

Diabetes Mellitus Type 2

Coronary Artery Disease

Hypothyroidism

Epilepsy

Diabetes Mellitus Type 1

Rheumatoid Arthritis

Cardiac Failure

Chronic Obstructive Pulmonary Disease

Glaucoma

Dysrythmias

Bipolar Mood Disorder

Parkinson’s Disease

Ulcerative Colitis

Cardiomyopathy Disease

Schizophrenia

Chronic Renal Disease

Systematic Lupus Erythromatosis

Chrohn’s Disease

Bronchiectasis

Multiple Sclerosis

Diabetes Insipidus

Addison’s Disease

Haemophilia

HIV

Figure 8: Chronic

0 10 20 30 40 50 60 70 80 90 100

Figure 16: Prevalence of chronic conditions in registered schemes

Medical savings accounts claims

as a percentage of total net claims

incurred went up from 10,9% in

2003 to 11,4% in 2004. The same fig-

ure increased to 13,1% from 12,7%

when viewed on a beneficiary basis. This would indicate a move towards benefit

designs requiring a greater proportion of benefits to be funded out of a member’s

savings rather than from the general risk pool.

Contributions and claims by open and restricted membership schemes

Table 10 and figures 18 and 19 show the contributions and claims per beneficiary

per month for open and restricted schemes.

Beneficiaries of restricted schemes saw lower gross contribution increases of

6,9% compared with the 7,4% for those in open scheme. Claims costs were high-

er in the restricted schemes than in the open ones. The risk claims ratio for open

schemes declined to 76,2% from 77,3% in 2003. The ratio for restricted schemes

increased to 84,3% from 83,6%.

Risk contributions and claims for registered schemes

Risk contributions (net of savings contributions) increased by 7,2% to R46bn

from R42,9bn in 2003. The comparable increase between 2002 and 2003 was

11,4%. Risk contributions per beneficiary per month increased to R577 from

R539, an increase of 7,1% (2003: 13,2%).

Risk claims increased by 6,5% to R36,2bn from R34,0bn (2003: 7,6%). Risk

claims per beneficiary went up to R453 per month from R426, an increase of

6,3%. (2003: 9,0%).

Medical savings accounts contributions and claims

Contributions to medical savings accounts increased by 9,9% to R5,5bn from

R5,0bn the year before. (2003: 19,0%). The increase per average beneficiary was

9,5% from R63 to R69 (2003:

21,2%).

Claims paid from savings

accounts increased by 9,5% to

R4,6bn from R4,2bn. (2003:

16,7%). Claims per beneficiary

were also 9,4% higher in 2004,

from R53 to R58. The comparable

increase between 2002 and 2003

was 17,8%.



4

306340

301

426453

342

409

476

539577

39 46 52 63 6934 41 45 53 58

0

100

200

300

400

500

600Rand PABPM

2000 01 02 03 04

Risk Claims Savings Claims Risk Contributions Savings Contributions

Figure 17: Risk and savings contributions and claims for registered schemes

Figure 11 shows that open schemes are increasingly paying claims out of med-

ical savings accounts; with 13% of all claims paid out of medical savings accounts

compared with 12,3% in 2003. Put another way, the claims ratio of medical sav-

ings accounts in open schemes increased to 85,1% in 2004 from 82,6% in 2003.



4

Risk Contributions Savings Contributions

42

50

57

7077

3136

3946

50

334

406

471

536574

361415

489546

583

0

100

200

300

400

500

600

700Rand PABPM

2000 01 02 03 04 2000 01 02 03 04Open Restricted

Risk Claims Savings Claims

3844

4958

65

2732

3439

41

292331

379414

437

333361

418456

491

0

100

200

300

400

500

600Rand PABPM

2000 01 02 03 04 2000 01 02 03 04Open Restricted

Figures 18 & 19: Risk and savings contributions and claims per average beneficiary per month for open and restricted schemes

Table 10: Contributions and claims per average beneficiary per month for open and restricted schemesRisk contributions Savings contributions Risk claims Savings claimsPABPM % PABPM % PABPM % PABPM %

R Change R Change R Change R Change

OPEN

2000 334 42 292 38

2001 406 21,8% 50 18,7% 331 13,3% 44 17,6%

2002 471 15,8% 57 14,2% 379 14,4% 49 10,8%

2003 536 13,8% 70 23,6% 414 9,1% 58 18,6%

2004 574 7,2% 77 8,8% 437 5,7% 65 11,9%

RESTRICTED

2000 361 31 333 27

2001 415 15,0% 36 14,6% 361 8,3% 32 17,6%

2002 489 17,8% 39 9,8% 418 15,8% 34 4,9%

2003 546 11,6% 46 17,1% 456 9,1% 39 15,3%

2004 583 6,8% 50 9,1% 491 7,7% 41 5,4%

*PABPM = per average beneficiary per month

Growth in restricted schemes claims paid out of medical savings accounts slowed to

7,7% in 2004 from 7,9% the year before. Medical savings accounts claims ratio for

restricted schemes declined to 82,1%, down from 85,0% in 2003.

Trends in contributions and claims since introduction of medical savingsaccounts

Figure 20 illustrates the increased utilisation of medical savings accounts in the

benefit design of all registered schemes since 1997 when schemes first started

using these. Risk contributions have increased by 60,5% and claims incurred

have gone up by 39,3% since 1997. Contributions to and claims from medical

savings accounts, on the other hand, have increased by 133,9% and 153,4%

respectively. This suggests that schemes are increasingly shifting benefits from the

Figures 22 and 23 shows the levels of claims

and non-health care expenditure after adjust-

ing contributions by removing the percentage

earmarked for reserves. The two figures show

that the claims ratios reduces by 5,8% com-

pared to non-health ratio which only reduces

by 1%.

Claims ratio for risk benefits

Figure 21 shows the relationship between risk

contributions and claims paid over the past

decade, adjusted for inflation. The claims ratio,

which is the percentage of contributions paid

out in claims, declined at a slower rate in 2004

compared to the last few years. The claims ratio

decreased to 78,6% from 79,2% in 2003 (claims ratio was over 90% before 1999).

The claims ratio effectively translates into medical schemes paying 78,6% (2003:

79,2%) of contributions towards benefits, leaving 21,4% (2003: 20,8%) of contri-

butions to non-health expenditure and reserves

(future benefits). As reserves for most schemes

are at the prescribed level, more of members’

contributions should in future be utilised

towards benefits. Trustees should ensure that

benefits are not substituted by high levels of

non-health expenditure.



4

0

100

200

300

400

500

600Rand PABPM

75

77

79

81

83

85

87

89

91

93

95

Risk Contributions Risk Claims Risk Claims Ratio

%Claims Ratio

95 96 97 98 99 2000 01 02 03 04

risk pool into the medical savings account. In

other words, it would appear that members are

effectively funding more benefits out of their

own pockets rather than being funded within

the risk pool.

Non-health expenditure

Medical schemes’ non-health expenditure consists of administration, brokers fees,

impaired receivables (bad debts), reinsurance results and expenditure associated

with managed care.

Administration expenditure

Administration expenditure in registered medical schemes grew 10,5% to R5bn

from R4,5bn in 2003. Open scheme expenditure was R4bn, an increase of 12,1%

from R3,5bn in 2003. Restricted schemes raised their expenditure by a more mod-

est 5,0% to R1,0bn from R978m.

Risk Contributions Savings Contributions Risk Claims Savings Claims

29 4463

4853

5664

69

0

100

200

300

400

500

600

700Rand PABPM

23 33 49 4348 48 53

58

95 96 97 98 199 2000 01 02 03 04

Figure 20: Risk and savings contributions and claims, 2004 prices

Figure 21: Risk claims ratio for all schemes since 1995 adjusted for inflation, 2004 prices

Gross Contribution Income Adjusted Gross Contribution IncomeOriginal Gross Non-health Ratio Adjusted Gross Non-health Ratio

0

100

200

300

400

500

600

700

Non-health Ratio

6

8

10

12

14

16

Rand PABPM%

95 96 97 98 99 2000 01 02 03 04



4

Risk Benefits Incurred Savings Benefits IncurredAdjusted Gross Claims Ratio Original Gross Claims Ratio

0

100

200

300

400

500

600Claims Ratio

75

77

79

81

83

85

87

89

91

93

95Rand PABPM%

95 96 97 98 99 2000 01 02 03 04

Figures 22 & 23: Claims ratio, non-health ratio and contributions since 1995 adjusted for reserve building and inflation, 2004 prices

Administration fees paid to administrators made up R3,7bn of the total (73,7%).

Staff remuneration and marketing expenses accounted for 10,2%, respectively.

Trustee remuneration represented 0,7% of gross administration expenditure whilst

principal officer fees represented 0,6%. Annexure O provides full details of these

expenditure items for each scheme.

Open schemes Restricted schemesPABPM PABPM

2004 2003 % 2004 2003 %R R Variance R R Variance

Direct administration fees 48,70 44,23 10,11% 33,83 31,79 6,42%

Co-administration fees 1,18 0,54 118,52% 0,50 0,55 -9,09%

Indirect expenses paid 0,81 0,80 1,25% 0,23 0,28 -17,86%

Total 50,68 45,57 11,24% 34,56 32,62 5,95%


Table 11 shows gross administration fees paid to third-party administrators

which comprises of direct administration fees, co-administration fees and indi-

rect expenses. The table shows that beneficiaries in open schemes paid on aver-

age 46,6% more for gross administration fees than restricted schemes in 2004

(2003: 39,7%).

Open schemes experienced an increase of 11,2% in the total administration

fees paid to third-party administrators; this increase is slightly lower than the over-

all increase in administration expenditure of 12,1% for open schemes. Restricted

schemes experienced an increase of 6,0% in the total administration fees paid to

third-party administrators; this increase is one percentage point higher than the

overall increase in administration expenditure of 5,0% for restricted schemes from

2003 to 2004.

Table 11: Total administration fees paid to third party administrators

In 2004, principal officer fees represented 0,6% of gross administration expen-

diture for open schemes compared to 1,1% in restricted medical schemes. This

translated into R0,43 per average beneficiary in the open scheme market (for those

schemes paying principal-officer fees), and R0,76 per average beneficiary in the

restricted scheme market; a difference of 76,7%.

Marketing and advertising fees represented 3,3% of gross administration

expenditure in respect of all registered schemes. Open schemes paid R0,93 per

average beneficiary per month for marketing and advertising, where as restricted

schemes paid R0,97 per average beneficiary per month, based on the number of

schemes that paid marketing and advertising expenditure. Interesting to note that

restricted schemes paid more towards marketing and advertising on an average

beneficiary level than open schemes.

Administration expenditure represented 69,8% (2003: 67,9%) of total non-

health expenditure.

Expenditure associated with management of benefits

Managed healthcare expenditure also jumped to R1,2bn from R1,1bn, an increased

of 11,8% from 2003. The average number of members covered by these interven-

tions grew by 1,2%. Managed care tools were used by 114 schemes during 2004

(2003: 109 schemes), and by 6 462 862 (97,1%) of beneficiaries (2003: 96,0%).

However, it should be noted that not all beneficiaries mentioned above are covered

by managed care due to some of the options not having managed care interventions.

Administration and managed-care expenditure jointly accounted for 12,1%

(2003: 11,7%) of gross contribution income, higher than the broad guideline of

10% that Council has established. Our analysis shows that there were 33 open

schemes, representing 2 992 999 beneficiaries, and 20 restricted schemes, repre-

senting 279 835 beneficiaries, whose overall administration expenditures were

still above the 10% level.

Table 12 shows administration and managed care expenditure for open and

restricted schemes by type of scheme administration. There were 7 self-adminis-

tered open schemes (2003: 9 schemes), representing 479 083 beneficiaries (2003:

511 885) and 42 third-party administered open schemes (2003: 40 schemes), rep-

resenting 4 238 353 beneficiaries (2003: 4 181 457).

Self-administered open schemes grew their expenditure by 10,9% to R77 pbpm

from R69 pbpm in 2003. Open schemes administered by third parties saw a rise

of 12,0% to R88 pbpm from R78 pbpm. The latter schemes spend 14,4% more on

administration and managed care expenditure than self-administered open

schemes.



4

There were also 13 self-administered restricted schemes (2003: 13 schemes), rep-

resenting 238 744 beneficiaries (2003: 247 264) and 74 third party administered

restricted schemes (2003: 75 schemes), representing 1 697 094 beneficiaries (2002:

1 711 556). Self-administered restricted schemes paid on average R43 pbpm com-

pared with the R59 pbpm spent by restricted schemes administered by third parties.

The expenditure by the latter schemes was 36,5% higher than the former.

In the restricted schemes market, only four

schemes reported any commission payments

(three in 2003). However, these schemes paid

R2,2m in commission, up 107,3% from 2003.

Data from these four schemes shows that only

5 318 new members joined the schemes in

2004. The three schemes that paid broker

commission in 2003 had seen 10 495 new

members joining, which suggests that the



4

OPEN SCHEMES RESTRICTED SCHEMESSelf -administered Third Party Self -administered Third Party

PABPM % PABPM % PABPM % PABPM % R Change R Change R Change R Change

2000 37,50 - 48,66 - 24,69 - 38,26 -

2001 62,83 67,5% 62,70 28,8% 31,26 26,6% 41,49 8,4%

2002 55,80 -11,2% 69,81 11,4% 37,31 19,4% 49,27 18,8%

2003 69,17 24,0% 78,38 12,3% 32,95 -11,7% 55,76 13,2%

2004 76,72 10,9% 87,78 12,0% 43,25 31,3% 59,02 5,9%


Table 12: Gross administration expenditure and managed care expenditure in respect of open and restricted schemes

Self-administered open schemes spent 77,4% more pbpm compared with self-

administered restricted schemes. Open schemes administered by third parties paid

on average 48,7% more pbpm than third-party administered restricted schemes.

This may be explained by the fact that:

• Restricted schemes usually have simpler benefit designs and fewer benefit

options, all of which results in simpler administration;

• Collection of contributions and credit control is much simpler for restricted

schemes; and

• Sometimes the employer group associated with a restricted scheme makes a

contribution to some of the capital and salary expenditure.

Fees paid to healthcare brokers

Commission fees paid to healthcare brokers again rose sharply to R704m from

R581m in 2003, an increase of 21,1%. Virtually all commission payments (99,7%)

were made by open schemes. Those schemes that paid broker commissions have

seen this expenditure increase as a percentage of gross contribution income to

1,9% from 1,7% in 2003. When expressed as a percentage of total non-health

expenditure, broker fees increased to 12,2% from 11,0% for those schemes that

paid broker fees.

Figure 24 shows trends in payments made

to brokers since 2000, as well as the percent-

age of total non-health expenditure that these

commissions have accounted for.

Per Average Member Per Month Percentage of Total Non-health Expenditure

15.6 16.8 17.0

26.3

30.9

02

6

10

14

18

22

26

30

34

Rand PAMPM

10.7

8.67.9

11.1

012345678910111213

%Percentage of non-health

12.4

2000 01 02 03 04

Figure 24: Trends in broker fees for the open scheme market

Marketing and advertising expenditure have

gone up year on year, without any perceptible

increase in many new members joining.

Schemes that had the highest increase in

broker fees pmpm and a decrease in the num-

ber of members joining between 2003 and

2004, are shown in table 13.

number joining in 2004 has gone down by 49,3% in spite of the substantial

increases in commission payments.



4

The 47 open schemes that paid broker fees during 2004 indicated that 390 873

new members joined the schemes during 2004, a decrease of 9,8% from the 433

904 new members that joined the open schemes that paid broker fees in 2003.

Data from open schemes shows that 168 767 people were introduced to med-

ical schemes for the first time in 2004, compared with 215 845 in 2003. This is a

decline of 21,8%. Restricted schemes, on the other hand, saw 52 982 newly-intro-

duced members, a decrease of 35,3% on 2003. The increase in broker fees of 21,1%

is therefore not related to the introduction of members.

Broker commission per member per month

Figure 25 illustrates the actual broker fees per member per month (based on the

industry’s overall average principal members) compared with a fee per member per

month that includes broker fees, marketing

expenditure as well as advertising expenditure.

Actual Broker Fees Broker Fees plus Marketing and Advertising Costs

14

18 18

32

38

1113

16

26

31

0

5

10

15

20

25

30

35

40Rand PAMPM

2000 01 02 03 04

Figure 25: Costs incurred in sourcing membership

Figure 26 excludes from the analysis the top

three schemes in table 13, and illustrates the

trends in broker fee pmpm since 2000. The

information is based only on the average num-

ber of members of those schemes that paid bro-

ker fees.

Actual Broker Fees Broker Fees (excl. outliers)

15.8

20.0 20.623.3

25.0

15.6 16.8 17.0

26.3

30.9

0

5

10

15

20

25

30

35Rand PABPM

2000 01 02 03 04

Figure 26: Broker fees excludes the top three outliers

The actual broker fee per average member

per month for the open industry market esca-

lated by approximately 17,2% between 2003

and 2004. However, should the three outliers be

removed, this increase to 7,5%, hence the bro-

ker fee per average member per month would

reduce from R31 per average member per

month to R25.

*PAMPM = per average member per month



4

Scheme name Type Broker fees paid Number of members joiningthe scheme

PAMPM PAMPM % Change 2004 2003 % Change2004 2003

R RBuilt Environment

Professional Associations Restricted 48,72 10,51 363,66% 378 1 173 -67,77%

Profmed Restricted 1,76 0,69 156,80% 2 542 4 029 -36,91%

Global Health Open 4,44 2,89 53,33% 2 152 13 298 -83,82%

Community Medical Aid

Scheme (COMMED) Open 12,76 8,83 44,45% 0 1 526 -100,00%

Topmed Medical Scheme Open 39,13 27,74 41,06% 1 357 1 520 -10,72%

Hosmed Medical Aid Scheme Open 7,65 5,67 34,87% 0 4 830 -100,00%

Discovery Health Medical

Scheme Open 41,69 32,72 27,42% 139 898 171 065 -18,22%

Medihelp Open 10,16 8,02 26,72% 9 055 9 589 -5,57%

Bestmed Medical Scheme Open 34,46 27,45 25,55% 9 095 11 376 -20,05%

SAMWUMED Restricted 0,19 - N/A 2 398 5 293 -54,69%

Table 13: Schemes with the largest increases in broker commission between 2003 and 2004

Reinsurance results

The number of reinsurance contracts entered into by schemes declined to 5 during

2004 from 10 the year before. Other reinsurance entries in a few schemes related

to prior year adjustments. The net effect was a decrease in the reinsurance deficit of

93,7%, decreasing to a deficit of R7,8m from R123m in 2003.

Impaired receivables

The total impaired receivables (previously known as bad debts) for the year

under review amounted to R211m compared to R321m in 2003, which is a

decrease of 34,3%. This movement resulted

from the net effect of the following three cat-

egories:

• The increase in impaired receivables writ-

ten off of approximately 45,2%.

• The increase in impaired receivables of

approximately 79,9%.

• The decrease in the provision for impaired

receivables of approximately 118,1%.

Impaired receivables for 2004 represented

3,0% of total non-health expenditure com-

pared to 4,8% in 2003.

There is some concern that medical

schemes have seen a 45,2% increase in

impaired receivables written off. This is espe-

Total Impaired Receivables – Open Total Impaired Receivables – Restricted

Contribution > 60 days as % of Arrear Contributions – Open

Contribution > 60 days as % of Arrear Contributions – Restricted

0

20

40

60

80

100

120

140

160

180

200Rand Million

0

5

10

15

20

25

30

35%

2000 01 02 03 04

Figure 27: Impaired receivables

cially so because the administration fee associated with the contributions being

provided for impaired receivable purposes is not recovered by schemes. The fluc-

tuation in impaired receivables over the years could be due to ineffective debt col-

lection systems and inappropriate manner of debtors ageing; currently 13,5% of

arrear contributions are over 60 days old (2003: 24,7%).

Medical schemes typically collected contributions within 9,3 days during 2004,

a decrease of 22,3% from 12 days in 2003. Though this is an improvement from

the prior period it is still a concern as Section 26(7) requires that all contributions

should be paid to a medical scheme not later than three days after payment is due.

The associated risk of not collecting contributions timely is the possible impair-

ment of the debtor and paying claims were contributions have not been received.



4

Year Total impaired Total impaired Contribution over 60 receivables receivables as % of days as % of arrear

non health expenditure contributionsOpen Restricted Open Restricted Open RestrictedR’000 R’000

2004 86 865 124 559 1,5% 8,6% 13,3% 14,6%

2003 188 582 132 657 3,6% 9,6% 26,4% 13,9%

2002 118 922 17 914 2,5% 1,6% 16,3% 17,4%

2001 172 872 23 754 4,0% 2,4% 29,5% 20,1%

2000 110 417 44 917 3,7% 4,5% 27,9% 14,2%

Table 14 shows that, in 2004, total impaired receivables were higher for restricted

schemes than for open schemes. As a general trend, however, the impairments for

restricted schemes are lower than for open schemes. Impaired receivables as a per-

centage of non-health expenditure were 8,6% for restricted schemes (2003: 9,6%)

and 1,5% for open schemes (2003: 3,6%).

Figure 28 shows the trends in impaired receivables over the last five years. The fig-

ure shows the actual amounts incurred and an adjustment for the four outlier schemes

which had the highest variances for the periods. The

trend over the five years looks more consistent with

the adjusted amounts. The full details on impaired

receivables are contained in Annexure R.

Table 15 shows total impaired receivables per

administrator as well as outstanding contribution

debtors over 60 days as a percentage of total con-

tribution debtors.

Total Impaired Receivables Adjusted Total Impaired Receivables

139125

105 10378

155

197

137

321

211

0

50

100

150

200

250

300

350Rand Million

2000 01 02 03 04

Figure 28: Actual impaired receivables compared to theimpaired receivables after the removal of the outliers

Trends in total non-health expenditure

Total non-healthcare expenditure for registered

schemes rose by approximately 7,6% to R7,1bn in

2004 from R6,6bn in 2003. As explained earlier,

Table 14: Impaired receivables: open vs restricted schemes since 2000



4

Administrator Number Total Outstandings Number Total Outstanding of impaired contributions of impaired contributions

schemes receivables > 60 days as schemes receivables > 60 days as% of arrear % of arrear

contributions contributions

2004 2004 2004 2003 2003 2003R’000 % R’000 %

Medscheme (Pty) Ltd 22 17 277 30,07% 21 28 119 45,06%

Self-administered 19 10 589 20,97% 19 14 875 18,09%

Metropolitan Health Corporate (Pty) Ltd 16 4 313 17,79% 16 87 255 70,01%

Old Mutual Healthcare (Pty) Ltd 11 5 546 26,88% 13 (802) 15,78%

Sovereign Health -Division of Medscheme Holdings 11 (400) 1,99% 11 589 0,21%

Status Medical Aid Administrators (Pty) Ltd 9 (91) 1,81% 9 3 144 3,29%

Allcare Administrators (Pty) Ltd 8 12 240 7,48% 7 1 032 6,19%

Discovery Health (Pty) Ltd 8 20 428 -0,91% 10 (1 772) -1,11%

Mx Network Systems (Pty) Ltd 3 113 942 82,91% 3 122 163 83,74%

Other 26 27 581 26,72% 28 66 635 31,51%

Total 133 211 424 13,54% 137 321 239 24,65%

administration expenditure increased by 10,5%, managed care by 11,8%, broker

fees rose by 21,1% and impaired receivables decreased by 34,2%. There was a

decrease of 93,6% in reinsurance losses.

Figure 29 shows the trends in total non-health expenditure since 2000. Total

non-health expenditure has increased by approximately 79,5% over the five year

period. Administration expenditure rose by 99,3%; managed care by 39,1%; bro-

g p

4 98

2

1 23

2

704

8

211

7 13

6

4 50

8

1 10

2

581

123 32

1

6 63

5

4 08

3

966

354

297

137

5 83

6

3 52

7

986

289

334

197

5 33

2

2 49

9

885

230

207

155

3 97

6

0

1

2

3

4

5

6

7

Rand Million‘000

Administration Managed Care: Broker Nett Impaired Total(Risk only) Management Fees Reinsurance Receivables Non-health

Services Expenditure

2000 2001 2002 2003 2004

Figure 29: Total non-health expenditure for registered schemes

*The figures in brackets are credits

Table 15: Impaired receivables per administrator

ker fees by 206,4%, and impaired receivables by 36,1%. Net reinsurance losses

have decreased by 96,2%. Total non-health expenditure rose to 13,9% (2003:

13,8%) of contributions in 2004.

Figure 30 shows further that non-health expenditure per beneficiary increased

to R1 045 from R981 in 2003, an increase of 6,5% in real terms. The downward

sloping claims ratio decreased, on the other hand, to 79,2% from 79,6% in 2003.

Total non-health expenditure was fairly stable in 2001 and 2003, but has increased

considerably in 2004. This increase in non-health expenditure was mainly due to

the 19,6% increase in broker fees to R102 per beneficiary from R85.

Given the reduction in the proportion of claims being paid to 79,2% from

79,6% in 2003, it would seem that claims are not necessarily putting upwards

pressure on contributions. The increase in contributions (6,0% in 2004) continue

to finance higher non-health expenditure.

Figure 31 depicts the information on risk

contributions, risk benefits, administration

costs and annual surpluses/(deficits) dis-

cussed previously on a beneficiary per

month basis. From the figure, it is clear that

the rate of increase on administration

expenditure per beneficiary has declined,

while the rate of growth of member sur-

pluses has increased considerably. The

implication is that, unlike in previous years

when gross administration expenses per

beneficiary were growing at the expense of

the beneficiary surpluses, this pattern has

now started to reverse.

The figure also shows that the growing divergence in contributions and claims

per member per month has not levelled off (as shown by increases in rate of con-

tribution changes accompanied by declines in claims ratios).

Operating results during 2004 and changesover the last five years

Total surplus from operations for all schemes has

increased steadily since 2001, and increased again

to R2,8bn from R2,4bn in 2003, a growth of

17,2%. Operating surpluses had grown by a dra-

matic 547,4% and 114,5% during 2002 and

2003, respectively. The 2004 increase, though not

as dramatic, is still significant and may be an

indication of a possible stabilisation of the indus-

try. The industry net surplus grows to R5bn when

investments and other income are taken into

account, an increases 14,1% compared to 2003.



4

0

200

400

600

800

1 000

1 200

Administration Expenditure (R+S) Managed Care: Management Services

Broker Fees Nett Reinsurance Other Claims ratio

Rand PBPA

70

75

80

85

90

95

100

Claims ratio

95 96 97 98 99 2000 01 02 03 04

Figure 30: Real non-health expenditure per beneficiary, 2004 prices

0

100

200

300

400

500

600Rand PBPM

95 96 97 98 99 2000 01 02 03 04

Risk Contributions Risk BenefitsAdministration & Managed Care: Management Services Nett Surplus/(Deficit)

Figure 31: Contributions, benefits and non-health expenditure, 2004 prices



4

Year Surplus/(Deficit) Net investment Net surplus/from operations and other income (deficit)

R’000 R’000 R’000 % Growth2000 (1 040 566) 1 230 398 189 832

2001 169 725 1 278 153 1 447 878 662,7

2002 1 098 795 1 366 273 2 465 068 70,3

2003 2 356 497 2 030 368 4 386 865 78,0

2004 2 761 092 2 243 551 5 004 643 14,1

Investments

Net investment and other income decreased

as a percentage of net surplus to 44,8% from

46,3%. The decrease has largely mirrored

changes in interest rates.

Figure 33 provides information on the

composition of investments of medical

schemes during 2004. In open schemes, a

greater proportion (67,1%) of investments

was held in cash and cash equivalents. Bonds

accounted for 21,5%, equities accounted for

5,9%, insurance policies for 3,7%, properties

for 1,2% and 0,6% for other investments.

Restricted schemes also held a larger propor-

tion of their investments, 63,4%, in cash and

cash equivalents. Bonds accounted for 12,7%,

equities and insurance policies made up

11,4% and 9,3%, respectively. Other invest-

ments and property accounted for smaller

proportions; each represented 2,0% and 1,3%

respectively of total investments made by

restricted schemes.

The primary obligation of a medical

scheme is to ensure that it has built up suffi-

cient assets to pay benefits due to members as

they fall due. Asset management must there-

fore be structured to the demands, nature and

timing of the expected liabilities of the

scheme. A medical scheme should spread its assets in such a manner that it

matches its liabilities and minimum accumulated funds at any point in time.

Hence, trustees need to monitor investments more closely to ensure not only

compliance with Annexure B, but also that appropriate diversification of risk is

achieved.

397 6891 170

237 218 190

1 448

2 465

4 3875 005

(234) (356)220

(739)(1 112) (1 041)

170

1 099

2 3562 761

(2 000)

(1 000)

0

1 000

2 000

3 000

4 000

5 000

6 000Rand Million

Operating Results Nett Surplus/(Deficit)

95 96 97 98 99 2000 01 02 03 04

Figure 32: Operating results

0

2

4

6

8

10

12Rand Billion

Cash and Cash Equivalents Bonds Equities

Properties Insurance Policies Other

Open Restricted

Figure 33: Composition of scheme investments

Table 16: Operating results for all schemes since introduction of the new Medical Schemes Act

Matching assets and liabilities

The difference between the schemes total assets and its total liabilities represents

the liquidity gap. A positive difference indicates that the scheme has sufficient

assets to meet its liabilities, while a negative one indicates illiquidity. However, it

is key to consider not only the total asset and liability position but also the peri-

ods within which liabilities must be paid and assets can be converted to cash

flows. This is where the financing risks must be matched.

Figure 34 compares the matching of assets and liabilities in open and restrict-

ed schemes. The current assets:current liabilities ratio for open schemes was 2,21,

and 2,88 for restricted schemes. The total asset:

total liability ratios were 2,76 and 4,17 for open

and restricted schemes respectively.

Medical schemes were required to imple-

ment accounting standard AC133, with a fur-

ther requirement during 2004 of preparing a

risk management report. This report assesses the

various risks that a medical scheme may be

exposed to over the short, medium and long

term, including the risk to liquidity.

The liquidity analyses were done for periods

up to 1 month; 1-3 months and 3-12 months.

The quality of the data was in some cases unre-

liable, with total figures in the liquidity reports

not reconciling to the balance sheet. This is dis-

appointing as these are supposedly audited figures. We observed the following

with regard to those schemes with a quick ratio (current assets: current liabilities)

below 2:

• Generally, these schemes held a high proportion of their total investments in

cash;

• For the period up to 3 months, some open schemes had low cash holding, low

claims paying ability yet had very high exposures to equity. This is a fairly risky

strategy, especially for schemes with no excess reserves. Restricted schemes gen-

erally had excess reserves and had low cash holdings, coupled with high expo-

sure to bonds and insurance policies. While the investment strategies were not

so conservative, this was buttressed by the existence of excess reserves;

• However, in those cases where the bulk of a medical scheme’s investments are

held through insurance policies, trustees must consider whether such policies

are suitable given the scheme’s financial position and short term nature of its

liabilities. In this regard, it is also important for trustees to ensure that the

investment mandate and policy of the scheme are not only compliant with the

requirements of Annexure B of the Act, but also allow for easy cashing in of

investments; and

• Similar trends were observed for period up to 1 year both restricted and open

schemes. Some schemes had low cash and near cash holdings and more expo-

sure to bonds and equity, and lower than average claims paying ability. In such



4

0

2

4

6

8

10

12

14

16

18

Rand Billion

Current Assets Current Liabilities Total Assets Total Liabilities

Open Schemes Restricted Schemes

Figure 34: Matching of assets and liabilities



4

cases, trustees must be mindful of the volatility and short-term performance of

equities, and the possible capital loss in the case of bond holdings. This is espe-

cially critical for the schemes sampled above, whose liquidity ratio was below

industry average of 2.

The principle of matching assets with liabilities is particularly important in the

context of liquidity. Trustees should guard against longer-term and riskier invest-

ment when the scheme’s liquidity is well below the industry average.

Net assets, accumulated funds and solvency

The required “minimum accumulated funds” established by Regulation 29 of the

Medical Schemes Act increased to 25% of gross contributions at year end

December 2004. These “minimum accumulated funds” are more commonly

referred to as the “reserves” of a scheme. When expressed as a percentage of gross

contributions they reflect the solvency level of the scheme.

Net assets, defined as total assets less total liabilities, rose 35,4% to R20,0bn in

2004 from R14,7bn in 2003 in respect of reg-

istered medical schemes. Reserves grew con-

comitantly by 34,5% to R18,5bn from

R13,7bn the year before.

The overall industry average solvency

increased as a result, to 36,6% as at December

2004 from 29,3% as at December 2003. This

level was more than the prescribed solvency

level of 25%. The solvency ratio of open

schemes was 27,9% compared with 20,9% in

2003. Restricted schemes continued their

high performance and achieved a solvency

ratio of 58% compared to 49,6% in 2003. On

an industry basis, restricted scheme members

have a higher average reserve position per

member than members of open schemes. Full

details of the solvency levels of the various

schemes are detailed in Annexure K and L.

Figures 35, 36 and 37 show the changes in

solvency for all schemes, open and restricted

schemes respectively, since the implementa-

tion of the new Medical Schemes Act. All three

figures reflect improvements in the solvency

ratios since 2000, with the overall ratio for all

registered schemes now exceeding the pre-

scribed minimum 25% level.

20.2 20.422.9

29.3

36.6

10.013.5

17.5

22.025.0

0

5

10

15

20

25

30

35

40Solvency ratio%

Prescribed Solvency Level Industry Average All

2000 01 02 03 04

Figure 35: Solvency position of all registered schemes

10.0 13.5

17.5

22.025.0

13.3 13.515.1

20.9

27.9

0

5

10

15

20

25

30

Solvency ratio%

Prescribed Solvency Level Industry Average Open

2000 01 02 03 04

Figure 36: Solvency trends since 2000 for open schemes

Table 17 shows, for open and

restricted schemes, the number of

members in the schemes that failed to

meet the prescribed solvency level

compared to the number of members

in schemes that attained the solvency

level. The relevant prescribed solvency

levels used in the table are 10%,

13,5%, 17,5%, 22% and 25% for

2000, 2001, 2002, 2003 and 2004

respectively.



4

34.2 36.341.3

49.6

58.0

10.013.5

17.522.0

25.0

0

10

20

30

40

50

60

70

Solvency ratio%

Prescribed Solvency Level Industry Average Restricted

2000 01 02 03 04

Figure 37: Solvency trends since 2000 for restricted schemes

Table 17: Prescribed solvency levels and number of members Open schemes Restricted schemes

Below Above Below AbovePrescribed Level Prescribed Level

Number of medical schemes 2000 15 33 15 86

2001 19 29 11 83

2002 24 25 7 86

2003 19 29 7 80

2004 18 30 4 81

Membership 2000 2 385 051 (51%) 2 291 048 839 029 (41%) 1 214 412

2001 2 650 934 (56%) 2 117 142 576 462 (29%) 1 419 862

2002 3 519 329 (74%) 1 211 882 251 050 (13%) 1 731 873

2003 3 426 988 (73%) 1 291 809 222 430 (11%) 1 730 574

2004 2 534 273 (53%) 2 221 030 80 160 (4%) 1 827 100

Table 17 and figure 38 illustrates that, for open schemes, the greater part of mem-

bers (53%) were in the 18 schemes that failed to meet the prescribed solvency

level in 2004 when compared to the number of members in the 30 open schemes

that attained the prescribed solvency level of 25%. This figure is skewed consid-

erably by the results of Discovery Health medical scheme. Should this largest open

scheme be removed from the analysis, only 20% of the members will be in the

group below the prescribed solvency level compared to 53% before. It should also

be noted that Discovery has also increased its solvency to over 23%, just below the

required 25%. These findings show that today more members of these schemes

enjoy greater solvency protection than ever before.

Restricted schemes, on the other hand, had the majority (only 4 of the 85

restricted schemes were below 25%) of their members within those schemes that

met the prescribed solvency level.

The Council has also instituted an early-warning system on financial soundness

made up of quarterly returns and a review of monthly management accounts in some

instances. This early-warning system is intended to enable the Registrar and trustees



4

to take proactive steps to resolve financial diffi-

culties when they occur. Table 18 compares sol-

vency levels reported in the 2004 final quarterly

returns with the solvency as reported in the audit-

ed statutory return as at December 2004. We also

compared these figures with budgeted estimates

provided as part of the quarterly returns. Overall,

there were no significant variations between the

quarterly and audited results on an industry wide

basis. At the level of individual schemes, material

changes were generally linked to adjustments

made in respect of provisions for outstanding

claims and provisions for impaired receivables. No. of MS – 2003 No. of MS – 2004 Membership – 2003 Membership – 2004

18

30

4

81

19

29

7

80

0

10

20

30

40

50

60

70

80

90No. of Medical Schemes

2 534 2 221

80

1 827

3 427

1 292

222

1 731

0

500

1 000

1 500

2 000

2 500

3 000

3 500

4 000ThousandsMembers

Below Above Below AbovePrescribed Level Prescribed Level Prescribed Level Prescribed Level

OPEN SCHEMES RESTRICTED SCHEMES

Figure 38: Prescribed solvency levels and number of members

Unaudited Audited Budget Audited Unaudited Audited vs AuditedActuals Actuals Actuals Actuals Unaudited vs Budget

2003 2003 % Variance 2004 2004 2004 % Variance % Variance

Open schemes 20,96% 20,88% -0,4% 25,30% 27,63% 27,94% 1,1% 10,4%

Restricted schemes 49,86% 49,57% -0,6% 50,97% 57,22% 57,95% 1,3% 13,7%

Total Registered schemes 29,40% 29,30% -0,4% 32,21% 36,17% 36,61% 1,2% 13,7%

Table 19: Comparison of selected indicatorsBudget Unaudited Audited Audited Audited

actuals actuals vs Budget vs Unaudited2004 2004 2004 % Variance % Variance

PAMPM PAMPM PAMPMOPEN SCHEMES

Gross Contributions R1 689 R1 607 R1 615 -4.4% 0.5%

Nett Claims Incurred R1 166 R1 087 R1 085 -7.0% -0.1%

Total Non-health Expenditure R248 R244 R249 -0.5% 2.0%

Nett claims ratio 77,09% 76,68% 76,19% -1.2% -0.6%

Non-health as a % of GCI 14,68% 15,20% 15,44% 5.2% 1.6%

Average Members 1 958 828 1 912 063 1 900 692 -3.0% -0.6%

RESTRICTED SCHEMES

Gross Contributions R1 791 R1 506 R1 530 -14.6% 1.6%

Nett Claims Incurred R1 448 R1 178 R1 187 -18.0% 0.8%

Total Non-health Expenditure R169 R150 R151 -10.4% 0.5%

Nett claims ratio 87,52% 84,87% 84,26% -3.7% -0.7%

Non-health as a % of GCI 9,41% 9,98% 9,87% 4.9% -1.1%

Average Members 680 064 812 825 801 044 17.8% -1.5%

Table 19 represents the budget estimates, the

quarterly and audited annual results. Monitoring

*PAMPM = per average member per month

Table 18: Solvency comparison between quarterly, audited annual and budget reports

Table 20 and figure 39 shows that, for schemes under close monitoring, solvency

improved by 35,4% during 2004. However, non-health expenditure per benefici-

ary was 10% higher than the industry average and benefits were below the indus-

try average. These schemes are in some cases only starting now to address the high

levels of non-health expenditure and increasing benefits to the open scheme

industry average.

In the case of the 12

schemes which were previous-

ly under close monitoring but

have now achieved the 25%

reserve level, average solvency

improved by 277,8% to

32,9% from 8,7% in 2000.

Non-health expenditure per

beneficiary was 9,4% lower

than the industry average

while benefits were 14%

below the industry average.



4

the accuracy of the budgeting process is crucial in ensuring that a scheme remains

financially viable, and any variance should be closely investigated.

Solvency, claims and non-health expenditure

Table 20 and figure 39 depict the relationships between the solvency position,

gross claims ratio and gross non-health expenditure of open schemes since 2000.

The table shows the results of schemes that were below 25% as at December

2004, and under our close monitoring programme and those that attained 25%

after being on close monitoring. New schemes that are below their respective

required phase-in solvency levels and schemes that amalgamated during the five-

year period were removed from the group for the sake of comparison.

Table 20: Solvency, claims ratio and non-health expenditure in open schemes

Solvency ratio Claims ratio Non-health ratioIndustry Industry Industryaverage < 25% > 25% average < 25% > 25% average < 25% > 25%

2000 13,35% 7,62% 8,70% 87,88% 85,59% 90,46% 15,27% 17,84% 13,90%

2001 13,47% 7,73% 10,35% 82,35% 78,90% 84,37% 16,81% 19,84% 15,49%

2002 15,05% 10,74% 11,16% 81,20% 77,26% 84,15% 15,50% 17,58% 14,47%

2003 20,88% 15,53% 19,69% 77,91% 76,15% 77,78% 15,40% 17,09% 14,32%

2004 27,89% 21,03% 32,87% 77,24% 76,86% 74,17% 15,49% 16,12% 15,66%

0

5

10

15

20

25

30

35Claims ratio

05

15

25

35

45

55

65

75

85

95%Non-health & Solvency ratio%

2000 01 02 03 04

<25% Solvency Ratio >25% Solvency Ratio Industry Average Solvency Ratio

<25% Claims Ratio >25% Claims Ratio Industry Average Claims Ratio

<25% Non-health Ratio >25% Non-health Ratio Industry Average Non-health Ratio

Figure 39: Solvency, claims and non-health expenditure ratios in open schemes



4

Figure 40 depicts the same rela-

tionships for restricted schemes and

shows that claims ratios in the

restricted schemes under close mon-

itoring are generally higher than that

of open schemes, although there has

been a tendency to reduce benefits

instead of non-health expenditure in

order to increase solvency. These

schemes should pay more attention

to reducing non-health expenditure,

which is currently still above the

restricted scheme industry average.

0

10

20

30

40

50

60Claims ratio

0

10

20

30

40

50

60

70

80

90

100%Non-health & Solvency ratio%

2000 01 02 03 04

<25% Solvency Ratio >25% Solvency Ratio Industry Average Solvency Ratio

<25% Claims Ratio >25% Claims Ratio Industry Average Claims Ratio

<25% Non-health Ratio >25% Non-health Ratio Industry Average Non-health Ratio

Figure 40: Solvency, claims and non-health in restricted schemes

Risk assessment framework, high impact medical schemes and solvency

The risk assessment regulatory framework that was adopted in 2003 has allowed

us to categorize schemes into three impact bands – low, medium and high – on

the basis of the systemic impact that a scheme’s failure might have on Council’s

goals and the industry.

Table 21 below shows the solvency position of the 25 schemes categorised as

high impact. Three (3) high impact schemes had solvency below 15% (2003: 5);

five showed solvency between 15% and 22% (2003: 7); while the remaining 17

schemes were above the 25% prescribed solvency (2003: 13).

Claims paying ability of medical schemes

A scheme’s financial soundness is also measured by its ability to pay claims from

cash and cash equivalents in the immediate future. Figure 41 depicts the claims

paying ability of schemes measured in months of cover. This is the number of

months’ claims that the scheme is able to cover from its existing cash and cash

equivalents. The cash coverage improved by 35,7% to 5,7 from 4,2 months in

2004, implying that schemes in general have improved their claims paying abili-

ty.

Schemes’ payment cycles reflect a similar trend of 22,9 days compared to the 22,4

Table 21: High-impact schemes per typeType of Average Contributions Gross Gross Solvency scheme beneficiaries PABPM claims ratio non-health ratio ratio

2004 2003 2004 2003 2004 2003 2004 2003 2004 2003Open 4 040 067 4 022 084 R662 R616 77,19% 77,69% 15,23% 15,35% 26,95% 19,52%

Restricted 870 035 861 658 R621 R585 85,52% 82,17% 9,77% 10,26% 49,26% 42,43%

Total 4 910 102 4 883 742 R654 R610 78,59% 78,45% 14,31% 14,49% 30,78% 23,49%




4

days in 2003. The provision for

outstanding claims, in terms of

months’ coverage, has

improved from 0,9 month to

0,8 months. The reduction in

the provision for unpaid claims

reflects an improvement in

schemes ability to pay claims

more timely. Details of individ-

ual scheme’s claims paying

ability are outlined in

Annexure N.

Medical schemes benefit options during 2004

There were 420 (2003: 415) benefit options in registered medical schemes during

2004. Open schemes accounted for 260 (61,9% ) of benefit options (2003: 253

options or 61,0%). Restricted membership schemes had 160 (38,1%) of all regis-

tered options (2003: 162 options or 39,0%). Open schemes had, on average, 5,4

options per scheme with an average membership of 7 400 per option. Restricted

schemes had an average of 1,9 options per schemes with an average membership

*GCI pbpm = Gross contribution income per beneficiary per month

*PMPM = per member per month

Table 22: Benefit options for open and restricted schemesOpen Restricted

schemes schemes TotalAll benefit options

Number of options 260 (61,9%) 160 (38,1%) 420 (100%)

Membership representing 1 924 343 (70,9%) 791 921 (29,1%) 2 716 264 (100%)

Number of Schemes 48 (36,1%) 85 (63,9%) 133 (100%)

Surplus from operations pmpm R89,88 R69,76 R84,01

Average GCI pbpm R642,42 R630,50 R639,02

Options with members > 2 500 42,3% 45,6% 43,6%


Membership representing 1 800 525 (71,8%) 706 145 (28,2%) 2 506 670 (100%)




Options with members < 2 500 57,7% 54,4% 56,4%


Membership representing 123 818 (59,1%) 85 776 (40,9%) 209 594 (100%)




0

5

10

15

20

25

30

35

40

45

Rand Million

2.0

2.6

3.5

4.2

5.7

0

1

2

3

4

5

6

Months covering

Cash and Cash Equivalents Gross Claims Incurred Months Covering

2000 01 02 03 04

Figure 41: Average gross claims covered by cash and cash equivalents



4

of 4 950 per option.

The number of benefit options with fewer than 2 500 members increased to

56,4% (237 options in 2004) from 55,4% (230) the year before. There were 150

(57,7%) open schemes benefit options with less than 2 500 members and 87

(54,4%) restricted schemes options with less than 2 500 members.

One hundred (42,2%) of options with less than 2,500 members incurred oper-

ating losses in 2004 compared with 74 options (32,2%) in 2003.

The remaining 183 options (2003:185) had more than 2 500 members per

option - averaging 13 698 members per option. Of these, 70 options representing

38,3% incurred operating losses (2003: 56 options representing 30,3%).

It would thus appear that options with less than 2 500 members are more like-

ly to incur operating losses. They also have higher contributions and attract high-

er administration costs than other options.

Open Restrictedschemes schemes Total

Loss making options

Representing of total options 43,9% 35,0% 40,5%



Number of schemes 42 (54,6%) 35 (45,4%) 77 (100%)

Deficit from operations pmpm (R126,05) (R95,91) (R116,20)


Loss making options with member < 2 500






Loss making options with member > 2 500






Table 23: Results of loss-making options

*GCI pbpm = Gross contribution income per beneficiary per month*PMPM = per member per month

Of the 420 benefit options within registered schemes during 2004, 170 (40,5%)

incurred operating losses. 114 (67,1%) of the loss making options were in open

schemes and 56 (32,9%) were in restricted membership schemes. The options with

less than 2,500 members realised an average R198 pmpm operating loss. Those

with more than 2 500 members made an average operating loss of R107 pmpm, or

a loss 1,85 times lower than the former options.



4

Open schemes Restricted schemesProfit making Loss making % Profit making Loss making %

options options variance options options varianceNumber of options 146 114 104 56

Representing 56,1% 43,9% 65,0% 35,0%

Average GCI pbpm R597,46 R773,90 -22,8% R623,16 R648,66 -3,9%

Claims ratio 68,44% 93,08% -26,5% 79,07% 96,86% -18,4%

Administration ratio 11,19% 9,73% 15,0% 7,00% 6,91% 1,3%

*GCI PBPM = gross contribution income per beneficiary per month

Table 24: Comparison of profit and loss-making options’ results

Table 24 illustrates that open schemes had a higher prevalence of loss making

options compared to restricted medical schemes. Many of the open scheme

options were also more expensive while offering fewer benefits.

The fundamental policies underpinning the Medical Schemes Act are commu-

nity rating of contributions, cross subsidisation by different risk profiles and open

enrolment. The proliferation of benefit options cuts across and undermines these

principles by reducing the size of the risk pools and may well result in a new form

of risk rating. Members requiring specialised and chronic cover may well be herd-

ed onto more expensive benefit options, which end up with smaller risk pools and

invariably incur losses.

Administrator market in 2004

Figure 42 illustrates the market share of administrators as well as self-administered

schemes, based on the number of beneficiaries administered at December 2004.

Figure 43 depicts the changes in the market share since 2000 for all schemes

based on the number of beneficiaries as administered by the various parties at

December of each year.

Sovereign Health 4,4%Other 23,1%

Discovery Health 24,0%

Medscheme 16,3%

Self Administered 10,8%MHG 8,6%Mx Network Systems 7,1%Old Mutual Healthcare 5,7%

Figure 42: Market share based on the number of beneficiaries



4

The market is dominated by five large

administrators who, together, hold

66% of the market. Sovereign Health

was owned by Medscheme Holdings at

end of the year under review.

Figures 44 and 45 indicate the

change in market shares for the five

largest administrators based on benefi-

ciaries of open and restricted schemes,

respectively. Discovery Pty (Ltd) has

increased its share of the open scheme

market to 30% in 2004 from 15% in

2000. The large drop in market share of

Medscheme in the restricted market in

2002 was due to the movement of one

scheme.

0

5

10

15

20

25

30

35

2000 2001 2002 2003 2004

Market share%

Discovery Medscheme Self MHG Mx Old Sovereign OtherHealth Administered Network Mutual Health

Systems Healthcare

Figure 43: Market share of all administrators based on the number of beneficiaries

2000 2001 2002 2003 2004 Open

%0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45

Other

MHG

Sovereign Health

Self Administered

Medscheme

Discovery Health

Figure 44: Market share of five largest administrators in the open schemes market

%0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45

2000 2001 2002 2003 2004 Restricted

Other

MHG

Sovereign Health

Self Administered

Medscheme

Discovery Health

Figure 45: Market share of five largest administrators in the restricted schemes market



4

Despite the concentration of market power in the large administrators, there

appears to be little or no economies of scale reflected in the level of administra-

tion fees. Administration fees paid by open schemes to the five largest adminis-

trators were between 20% and 40% higher than the average for open scheme mar-

ket. Fees paid by restricted schemes were 30% to 50% higher than the market aver-

Name of Administrator No Beneficiaries Gross Fees paid to Gross Riskof Administration administrators Contributions Claims

Schemes Costs RatioMarket As % As %Share PABPM of GCI PABPM of GCI PABPM

2004 2004 2004 2004 2004 2004 2004 2004% R % % R %

Discovery Health (Pty) Ltd 1 32,02% 84,72 11,84% 68,78 9,62% 715,26 68,67%

Medscheme (Pty) Ltd 4 18,77% 51,99 8,68% 39,09 6,53% 598,97 78,75%

Self administered 7 10,16% 65,65 7,77% - 0,00% 845,29 86,26%

Old Mutual Healthcare (Pty) Ltd 4 5,09% 61,68 11,85% 50,97 9,79% 520,47 83,98%

Exclusive Health (Pty) Ltd 1 4,63% 89,51 17,17% 56,90 10,91% 521,42 58,26%

Sovereign Health -

Division of Medscheme Holdings 4 4,22% 62,02 8,40% 54,23 7,35% 738,28 81,55%

Allcare Administrators (Pty) Ltd 3 3,86% 58,43 12,43% 50,23 10,69% 469,92 82,03%

Rowan Angel (Pty) Ltd 1 3,74% 54,25 11,13% 46,82 9,61% 487,37 68,16%

Sizwe Medical Services (Pty) Ltd 1 3,32% 66,29 10,50% 53,53 8,48% 631,30 70,10%

Multimed 1 2,48% 63,24 8,77% 46,77 6,48% 721,35 87,43%

Sigma Health Fund Managers (Pty) Ltd 1 2,48% 57,80 9,48% 30,72 5,04% 609,92 92,50%

Metropolitan Health Corporate (Pty) Ltd 2 1,92% 74,86 10,96% 39,99 5,85% 683,34 88,40%

Medical Aid Administration Experts (Pty)Ltd 1 1,43% 123,91 25,94% 49,84 10,43% 477,76 54,97%

Amanzi Health Administrators (Pty) Ltd 1 1,32% 63,40 9,92% 50,14 7,84% 639,30 91,86%

Status Medical Aid Administrators (Pty) Ltd 5 1,27% 73,66 10,54% 65,00 9,30% 699,14 82,92%

Prosperity Health Corporate Fund

Managers (Pty)Ltd 2 0,87% 63,48 16,62% 43,40 11,36% 381,94 79,04%

African Life Health (Pty) Ltd 1 0,64% 52,24 14,21% 23,85 6,49% 367,51 75,72%

Definiti Medical Fund Managers (Pty) Ltd 1 0,48% 62,61 16,39% 54,44 14,25% 381,90 74,64%

Private Health Administrators 1 0,38% 99,00 15,88% 57,60 9,24% 623,54 79,94%

Hall Adminstrator cc 1 0,32% 114,88 25,12% 74,95 16,39% 457,38 63,48%

Integrated Healthcare (Pty) Ltd 1 0,27% 41,13 8,83% 36,71 7,88% 465,60 72,64%

Benmed Medical Scheme

Administrators (Pty) Ltd 1 0,15% 92,81 15,66% 58,19 9,82% 592,47 69,93%

Supreme Health Administrators (Pty) Ltd 1 0,08% 8,12 12,96% 7,85 12,54% 62,64 96,04%

Thebe ya Bophelo Healthcare Administration 1 0,06% 39,78 13,76% 31,80 11,01% 288,97 61,87%

Mx Network Systems (Pty) Ltd 1 0,05% 106,34 26,07% 18,66 4,57% 407,91 59,94%

Active Health 1 0,01% 37,95 10,11% 24,59 6,55% 375,28 85,13%

Average 70,17 10,79% 48,70 7,49% 650,57 76,19%

Table 25: Administrator market share since 2000 based number of beneficiaries – open schemes



4

age for restricted schemes.

The open scheme market has shown a significant swing from self-administra-

tion to the large third party administrators, while restricted schemes have not seen

the same movement from self administered towards the large third party admin-

istrators.

Tables 25 and 26 illustrates the market share based on the number of benefi-

ciaries to whom services are being delivered by third party administrators as well

as those beneficiaries of self administered schemes, and the average cost of admin-

istration. Gross administration costs comprise administration costs charged both

to the risk pool and to the savings accounts. The administration fee includes co-

administration fees as well. It should also be noted that although Sovereign

Health was a division of Medscheme, its results have been disclosed separately.

Table 26: Administrator market share since 2000 based number of beneficiaries – restricted schemesName of Administrator No Beneficiaries Gross Fees paid to Gross Risk

of Administration administrators Contributions ClaimsSchemes Costs Ratio

Market As % As %Share PABPM of GCI PABPM of GCI PABPM

2004 2004 2004 2004 2004 2004 2004 2004% R % % R %

Metropolitan Health Corporate (Pty) Ltd 14 24,97% 45,19 7,17% 35,67 5,66% 630,67 88,22%

Mx Network Systems (Pty) Ltd 2 24,38% 36,52 5,93% 31,23 5,07% 616,07 80,31%

Self administered 13 12,33% 36,52 6,47% 0,97 0,17% 564,26 85,88%

Medscheme (Pty) Ltd 18 10,19% 41,60 5,61% 33,84 4,57% 740,92 82,50%

Old Mutual Healthcare (Pty) Ltd 9 7,25% 38,01 6,59% 43,50 7,54% 577,15 95,19%

Sovereign Health -Division of

Medscheme Holdings 7 4,80% 58,33 7,84% 51,06 6,86% 743,91 80,03%

Discovery Health (Pty) Ltd 8 4,39% 55,63 9,72% 46,61 8,14% 572,48 84,02%

PPS Insurance Co Ltd 1 3,63% 63,68 10,85% 54,86 9,34% 587,16 74,79%

Providence Healthcare Risk Managers (Pty) Ltd 2 1,91% 54,74 8,43% 46,71 7,19% 649,38 70,25%

Eternity Private Health (Pty) Ltd 1 1,73% 93,85 11,41% 82,28 10,01% 822,22 82,24%

Allcare Administrators (Pty) Ltd 5 1,63% 64,51 9,48% 57,37 8,43% 680,69 95,07%

Status Medical Aid Administrators (Pty) Ltd 4 1,53% 42,39 6,82% 35,43 5,71% 621,09 88,05%

Mpumalanga Managed Health Care (Pty) Ltd 1 0,78% 34,93 4,71% - 0,00% 741,68 89,85%

Amanzi Health Administrators (Pty) Ltd 1 0,36% 78,06 11,88% 65,63 9,99% 657,14 85,52%

Integrated Healthcare (Pty) Ltd 1 0,10% 64,96 9,43% 57,86 8,40% 689,16 69,64%

Average 44,24 6,99% 33,83 5,34% 632,94 84,26%



4


ANNEXURE A5

Compliancewith submission of audited financial statementsand statutory returns

Section 37 of the Act requires that every medical scheme submit to the Registrar its

audited annual financial statements and statutory returns by 30 April in respect of

its financial year. A number of faulty or incomplete returns have once again

delayed the processing of the data. Better co-operation from the schemes in this

regard will be appreciated.

The following medical schemes submitted their documentation after the deadline

required by the Act. Section 66(3) requires that penalties be imposed on such

schemes unless good cause can be shown for the late submission of the returns.

1. Baymed (auditor’s management report + investment schedule)

2. Bestmed (auditor’s management report)

3. Bonitas (auditor’s management report + BOT report)

4. Commed (all required returns)

5. Eclipse (auditor’s management report)

6. Free State (auditor’s management report)

7. Hosmed (all required returns)

8. Ingwe (auditor’s management report)

9. Liberty (all required returns)

10. Lifemed (all required returns)

11. Munimed (all required returns)

12. Protector (all required returns)

13. Thebemed (AFS, BOT report & auditor’s management report)

14. ABI (auditor’s management report)

15. AECI (auditor’s management report)

16. Aranda (all required returns)

17. CAMAF (all required returns)

18. Mascom (auditor’s management report)

19. Moremed (all required returns)

20. Naspers (all required returns)

21. Old Mutual Staff (BoT Report)

22. Parmed (auditor’s management report)

23. Profmed (auditor’s management report)

24. Randwater (all required returns)

25. Polmed (auditor’s management report)

26. Transmed (auditor’s management report)

27. Umed (auditor’s management report)

28. Umvuzo (auditor’s management report)

29. Polprismed (all required returns)


ANNEXURE A5

The following schemes’ financial statements and/or returns were initially rejected

in terms of Section 38. The necessary changes have been made by the schemes and

revised financial statements have been submitted.

Ref no. Name1589 Baymed

1121 Klerksdorp Medical Benefit Society (KDM)

1214 Old Mutual Staff Medical Aid Scheme

1587 Pathfinder Medical Scheme

1454 Pro Sano Medical Scheme

1196 Protea Medical Aid Society

1575 Resolution Health Medical Scheme

1531 Sedmed

1544 Tiger Brands Medical Scheme

1582 Transmed Medical Fund

The following schemes’ financial statements and/or returns were rejected. The

necessary changes have been made in accordance with the Registrar’s interpreta-

tion of the events. The revised financial statements have not yet been resubmitted

by the schemes at time of printing.

Ref no. Name1170 NBC Medical Scheme

1158 Cawmed Medical Scheme

1561 Gen-Health Medical Scheme

1149 Medihelp

1557 Samancor Health Plan

1147 Telemed

1486 Sizwe Medical Fund

1565 Venda Police and Prisons Medical Scheme (Polprismed)


ANNEXURE B5

Composition of the Council during 2004-5

The composition of Council was as follows during the year under review:

Chairperson

Dr Nicky Padayachee, Formerly Dean of the Faculty of Health Sciences,

University of Cape Town.

Deputy Chairperson

Ms. Gando Matyumza, General Manager, Eskom KZN.

Dr. Siva Pillay, Medical Practitioner in Uitenhage, Eastern Cape

until 30 July 2004.

Professor Heather McLeod, Associate Professor of Actuarial Science, University

of Cape Town

Dr. Reno Morar, Director, Cape Clothing Benefit Fund

Dr. Kamy Chetty, Deputy-Director-General, National Department of

Health.

Dr. Jakes Jekwa, Medical Practitioner, East London

Mr. Barry Crookes, Formerly CEO of Old Mutual Employee Benefits

division, Retired Actuary

Mr. Boissie Mbha, Attorney in private practice and Acting Judge of the

High Court – until May 2004.

Ms. Nomonde Mgumane, Senior Consultant in mediation and arbitration.

Mr John Murphy, Acting Judge of the Labour Court and former

Pension Funds Adjudicator

Dr. MS Kariem, Chief Operations Officer, Groote Schuur Hospital,

University of Cape Town

REG

ISTE

RED

SC

HEM

ESBA

RGA

ININ

G C

OU

NC

IL S

CH

EMES

CO

NSO

LID

ATED

Per A

vera

ge M

embe

rPe

r Ave

rage

Ben

efic

iary

2004

2003

%20

0420

03%

2004

2003

%20

0420

03%

2004

2003

%

R’00

0R’

000

Cha

nge

R’00

0R’

000

Cha

nge

R’00

0R’

000

Cha

nge

RR

Cha

nge

RR

Cha

nge

ASS

ETS

No

n-cu

rren

t A

sset

s7

900

570

704

809

012

,10

1910

025

715

3-9

2,57

791

967

07

305

242

8,41

281

2,75

264

5,84

6,31

114

8,09

106

5,61

7,74

Prop

erty

,Pla

nt a

nd E

quip

men

t22

952

011

980

891

,57

508

25

486

-7,3

723

460

112

529

387

,24

83,3

245

,38

83,6

134

,01

18,2

886

,08

Inve

stm

ents

766

574

96

928

282

10,6

414

018

251

667

-94,

437

679

767

717

994

96,

962

727,

542

600,

464,

891

113,

321

047,

336,

30O

ther

Non

-cur

rent

Ass

ets

530

2-

N/A

--

0,00

530

2-

N/A

1,88

-N

/A0,

77-

N/A

Cur

rent

Ass

ets

2103

324

515

798

664

33,1

352

571

919

346

717

1,74

2155

896

415

992

130

34,8

17

656,

875

792,

1032

,20

312

5,35

233

2,75

33,9

8In

vent

orie

s19

111

242

768

7,55

961

100

3-4

,12

2007

33

429

485,

337,

131,

2447

3,98

2,91

0,50

481,

71A

ccou

nts

Rec

eiva

ble

173

432

42

355

331

-26,

3778

396

5942

731

,92

181

272

02

414

758

-24,

9364

3,80

874,

59-2

6,39

262,

7935

2,24

-25,

40C

ash

and

Cas

h Eq

uiva

lent

s19

279

809

1344

090

643

,44

446

362

133

037

235,

5219

726

171

1357

394

345

,32

700

5,94

491

6,27

42,5

12

859,

651

980,

0244

,43

Tota

l Ass

ets

2893

381

522

846

753

26,6

454

481

945

061

920

,90

2947

863

423

297

373

26,5

310

469,

628

437,

9424

,08

427

3,44

339

8,36

25,7

5

FUN

DS

AN

D L

IABI

LIT

IES

Mem

bers

’ Fun

ds19

999

605

1477

471

135

,36

439

379

367

329

19,6

120

438

984

1514

204

034

,98

725

9,10

548

4,21

32,3

62

962,

982

208,

7534

,15

Acc

umul

ated

Fun

ds18

232

507

1342

641

635

,80

438

741

366

690

19,6

518

671

248

1379

310

635

,37

663

1,27

499

5,64

32,7

42

706,

722

011,

9934

,53

Rev

alua

tion

Res

erve

- In

vest

men

ts70

303

741

789

568

,23

326

326

0,00

703

362

418

221

68,1

824

9,81

151,

4764

,92

101,

9661

,01

67,1

4R

eval

uatio

n R

eser

ve -

Pro

pert

y,Pl

ant

and

Equi

pmen

t20

878

639

922

6,25

--

0,00

2087

86

399

226,

257,

412,

3221

9,92

3,03

0,93

224,

23R

eser

ves

Set A

side

for

Spec

ific

Purp

oses

550

375

487

562

12,8

8-

-0,

0055

037

548

756

212

,88

195,

4717

6,59

10,6

979

,79

71,1

212

,19

Oth

er R

eser

ves

492

808

436

439

12,9

231

331

30,

0049

312

143

675

212

,91

175,

1415

8,18

10,7

271

,49

63,7

112

,21

No

n-cu

rren

t L

iabi

litie

s26

856

419

473

937

,91

291

12

293

26,9

427

147

519

703

237

,78

96,4

271

,36

35,1

139

,35

28,7

436

,93

Borr

owin

gs85

700

4921

974

,12

-12

9-1

00,0

085

700

4934

873

,66

30,4

417

,87

70,2

912

,42

7,20

72,5

9O

ther

Non

-cur

rent

Lia

bilit

ies

182

864

145

520

25,6

62

911

216

434

,52

185

775

147

684

25,7

965

,98

53,4

923

,35

26,9

321

,54

25,0

2

Cur

rent

Lia

bilit

ies

866

564

67

877

303

10,0

110

252

980

997

26,5

88

768

175

795

830

010

,18

311

4,10

288

2,37

8,04

127

1,10

116

0,87

9,50

Savi

ngs

Plan

Lia

bilit

y3

697

416

306

386

620

,68

361

797

-54,

713

697

777

306

466

320

,66

131

3,30

110

9,97

18,3

253

6,06

447,

0419

,91

Acc

ount

s Pa

yabl

e2

505

498

220

064

813

,85

5196

636

475

42,4

72

557

463

223

712

314

,32

908,

3181

0,25

12,1

037

0,75

326,

3313

,61

Prov

isio

n fo

r O

utst

andi

ng C

laim

s2

462

732

261

278

8-5

,74

5020

243

726

14,8

12

512

934

265

651

4-5

,40

892,

4996

2,15

-7,2

436

4,29

387,

50-5

,99

Tota

l Fun

ds a

nd L

iabi

litie

s28

933

815

2284

675

326

,64

544

819

450

619

20,9

029

478

634

2329

737

326

,53

1046

9,62

843

7,94

24,0

84

273,

443

398,

3625

,75


ANNEXURE C5

Cons

olid

ated

bal

ance

she

etas

at

31 D

ecem

ber

2004

Consolidated balance sheet

Note

s:•

PAM

PM

= p

er a

vera

ge m

emb

er p

er m

on

th•

PAB

PM

= p

er a

vera

ge b

enef

icia

ry p

er m

on

th

REG

ISTE

RED

SC

HEM

ESBA

RGA

ININ

G C

OU

NC

IL S

CH

EMES

CO

NSO

LID

ATED

PAM

PMPA

BPM

2004

2003

%20

0420

03%

2004

2003

%20

0420

03%

2004

2003

%R’

000

R’00

0C

hang

eR’

000

R’00

0C

hang

eR’

000

R’00

0C

hang

eR

RC

hang

eR

RC

hang

eG

ross

Con

trib

utio

n In

com

e51

531

439

4803

161

57,

2967

947

860

362

212

,57

5221

091

748

635

237

7,35

154

5,27

146

7,91

5,27

630,

7459

1,20

6,69

(Sav

ings

Con

trib

utio

n In

com

e)(5

498

064)

(504

433

9)8,

99(5

43)

(757

)-2

8,28

(549

860

7)(5

045

095)

8,99

-162

,74

-152

,27

6,88

-66,

43-6

1,33

8,32

(Net

t C

laim

s In

curr

ed)

(36

166

094)

(34

026

289)

6,29

(545

486)

(485

267)

12,4

1(3

671

158

0)(3

451

155

6)6,

37-1

086,

54-1

041,

634,

31-4

43,5

0-4

19,5

15,

72O

wn

Faci

lity

Surp

lus/

(Def

icit)

(907

5)(2

198)

312,

84(1

988

3)(1

811

5)9,

76(2

895

8)(2

031

3)42

,56

-0,8

6-0

,61

39,7

9-0

,35

-0,2

541

,68

Gro

ss U

nder

wri

ting

Res

ults

985

820

58

958

790

10,0

411

356

699

483

14,1

69

971

771

905

827

310

,08

295,

1327

3,40

7,95

120,

4711

0,11

9,40

(Adm

inis

trat

ion

Expe

nditu

re)

(498

155

4)(4

507

526)

10,5

2(5

070

3)(5

685

4)-1

0,82

(503

225

7)(4

564

379)

10,2

5-1

48,9

4-1

37,7

68,

11-6

0,79

-55,

489,

57(M

anag

ed c

are:

Man

agem

ent

Serv

ices

)(1

231

543)

(110

154

8)11

,80

(20

056)

(964

8)10

7,87

(125

159

9)(1

111

196)

12,6

4-3

7,04

-33,

5410

,45

-15,

12-1

3,51

11,9

4(B

roke

r Fe

es)

(704

102)

(581

304)

21,1

2-

-0,

00(7

0410

2)(5

8130

4)21

,12

-20,

84-1

7,54

18,7

8-8

,51

-7,0

720

,38

Net

t R

e-in

sura

nce

Surp

lus/

(Def

icit)

(782

5)(1

2333

5)-9

3,66

--

0,00

(782

5)(1

2333

5)-9

3,66

-0,2

3-3

,72

-93,

78-0

,09

-1,5

0-9

3,69

Net

t U

nder

wri

ting

Res

ults

293

318

12

645

077

10,8

942

808

3298

129

,79

297

598

92

678

058

11,1

288

,08

80,8

38,

9735

,95

32,5

510

,44

(Impa

ired

Rec

eiva

bles

Wri

tten

Off)

(246

822)

(169

993)

45,2

0-

(60)

100,

00(2

4682

2)(1

7005

3)45

,14

-7,3

1-5

,13

42,3

3-2

,98

-2,0

744

,25

Impa

ired

Rec

eiva

bles

Rec

over

ed7

239

402

479

,88

--

0,00

723

94

024

79,8

80,

210,

1276

,39

0,09

0,05

78,7

6(In

crea

se)/

Dec

reas

e in

Pro

visi

on fo

r Im

pair

ed R

ecei

vabl

es28

159

(155

270)

118,

14(3

473)

(262

)12

24,1

124

686

(155

532)

115,

870,

73-4

,69

115,

560,

30-1

,89

115,

77

Sur

plus

/(D

efic

it)

fro

m O

pera

tio

ns2

721

757

232

383

817

,12

3933

532

659

20,4

42

761

092

235

649

717

,17

81,7

271

,12

14,9

033

,36

28,6

416

,45

Oth

er In

com

e/(E

xpen

ditu

re)

247

037

213

794

15,5

539

9(5

25)

175,

9024

743

521

326

916

,02

7,32

6,44

13,7

72,

992,

5915

,30

Net

t In

vest

men

t In

com

e1

492

868

162

062

1-7

,88

3093

237

739

-18,

041

523

800

165

835

9-8

,11

45,1

050

,05

-9,9

018

,41

20,1

6-8

,68

Unr

ealis

ed G

ains

/(Los

ses)

on

Re-

mea

sure

men

t of

Fin

anci

al In

stru

men

ts a

nd In

vest

men

t Pr

oper

ties

223

793

155

739

43,7

03

406

-N

/A22

719

915

573

945

,88

6,72

4,70

43,0

52,

741,

8944

,98

Rea

lised

Gai

ns/(

Loss

es)

on D

ispo

sal o

f Fi

nanc

ial I

nstr

umen

ts a

nd In

vest

men

t Pr

oper

ties

3799

4(1

433)

2751

,49

-(6

4)10

0,00

3799

4(1

497)

2637

,41

1,12

-0,0

525

88,1

90,

46-0

,02

2621

,72

Rea

lised

Gai

ns/(

Loss

es)

on D

ispo

sal o

f A

vaila

ble-

for-

sale

Fin

anci

al In

stru

men

ts19

820

7(1

116

6)18

75,0

3-

-0,

0019

820

7(1

116

6)18

75,0

35,

87-0

,34

1840

,60

2,39

-0,1

418

64,0

6Su

rplu

s/(D

efic

it) o

n Sa

le o

f Inv

estm

ents

Pr

oper

ties

927

922

067

-57,

95-

-0,

009

279

2206

7-5

7,95

0,27

0,67

-58,

770,

110,

27-5

8,21

Surp

lus/

(Def

icit)

on

Sale

of P

rope

rty,

Plan

t an

d Eq

uipm

ent

(161

)7

612

-102

,12

162

3438

0,35

07

645

-100

,00

0,00

0,23

-100

,00

0,00

0,09

-100

,00

(Impa

irm

ent

Loss

es o

n Fi

nanc

ial I

nstr

umen

ts

and

Prop

erty

Plan

t an

d Eq

uipm

ent)

(363

)(1

491

8)-9

7,56

--

0,00

(363

)(1

491

8)-9

7,56

-0,0

1-0

,45

-97,

61-0

,00

-0,1

8-9

7,58

Rev

ersa

l of P

revi

ous

Rec

ogni

sed

Impa

irm

ent

Loss

es o

n Fi

nanc

ial I

nstr

umen

ts a

nd P

rope

rty,

Plan

t an

d Eq

uipm

ent

-87

1-1

00,0

0-

-0,

00-

871

-100

,00

-0,

03-1

00,0

0-

0,01

-100

,00

NE

TT

SU

RP

LU

S/(

DE

FIC

IT)

493

041

04

317

023

14,2

174

233

6984

26,

295

004

643

438

686

514

,08

148,

1213

2,40

11,8

760

,46

53,3

313

,38


ANNEXURE D5

Cons

olid

ated

inc

ome

stat

emen

tfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20

04Consolidated income statement

REG

ISTE

RED

SC

HEM

ESBA

RGA

ININ

G C

OU

NC

IL S

CH

EMES

CO

NSO

LID

ATED

Per A

vera

ge M

embe

rPe

r Ave

rage

Ben

efic

iary

2004

2003

%20

0420

03%

2004

2003

%20

0420

03%

2004

2003

%R’

000

R’00

0C

hang

eR’

000

R’00

0C

hang

eR’

000

R’00

0C

hang

eR

RC

hang

eR

RC

hang

eA

CC

UM

ULA

TED

FU

ND

SBa

lanc

es a

t th

e Be

ginn

ing

of t

he Y

ear

1344

976

69

269

332

45,1

036

468

230

013

621

,51

1381

444

89

569

468

44,3

64

906

346

641

,56

200

31

396

43,4

7-

As

Prev

ious

ly R

epor

ted

1342

641

69

229

085

45,4

836

669

029

946

922

,45

1379

310

69

528

554

44,7

64

899

345

141

,95

200

01

390

43,8

6-

Pri

or Y

ear

Adj

ustm

ent

2335

044

151

99,0

5(2

008)

667

-400

,90

2134

31

108

1826

,36

80

1789

,00

30

1814

,46

- A

C 1

33 T

rans

ition

Adj

ustm

ent

-39

806

-100

,00

--

0,00

-39

806

-100

,00

-14

-100

,00

-6

-100

,00

Net

t Su

rplu

s/(D

efic

it) fo

r th

e Ye

ar4

930

410

431

702

314

,21

7423

369

842

6,29

500

464

34

386

865

14,0

81

777

158

911

,87

726

640

13,3

8U

nrea

lised

Gai

ns/(L

osse

s) o

n R

e-m

easu

rem

ent

of F

inan

cial

Inst

rum

ents

and

Inve

stm

ent

Prop

ertie

s(2

383)

(351

0)-3

2,12

--

0,00

(238

3)(3

510)

-32,

12-1

-1-3

3,43

-0-1

-32,

54Tr

ansf

er t

o/(fr

om) A

ccum

ulat

ed F

unds

(56

466)

(42

323)

33,4

2-

(320

2)10

0,00

(56

466)

(45

526)

24,0

3-2

0-1

621

,63

-8-7

23,2

6-

Due

to

Am

alga

mat

ion

734

9(4

772)

253,

990

(251

)10

0,00

734

9(5

023)

246,

303

-224

3,46

1-1

245,

39-

Due

to

Re-

mea

sure

men

t of

Fin

anci

al

Inst

rum

ents

and

Inve

stm

ent

Prop

ertie

s(8

581)

(52

349)

-83,

61-

-0,

00(8

581)

(52

349)

-83,

61-3

-19

-83,

93-1

-8-8

3,71

- O

ther

Tra

nsfe

rs(5

523

3)14

798

-473

,25

(0)

(295

1)-1

00,0

0(5

523

3)11

847

-566

,23

-20

4-5

57,1

9-8

2-5

63,3

5O

ther

(88

820)

(114

106)

-22,

16(1

75)

(85)

104,

20(8

899

4)(1

1419

1)-2

2,07

-32

-41

-23,

58-1

3-1

7-2

2,55

Bala

nces

at

the

End

of t

he Y

ear

1823

250

713

426

416

35,8

043

874

136

669

019

,65

1867

124

813

793

106

35,3

76

631

499

632

,74

270

72

012

34,5

3

REV

ALU

ATIO

N R

ESER

VE

(INV

EST

MEN

TS)

Bala

nces

at

the

Begi

nnin

g of

the

Yea

r41

740

521

790

891

,55

326

326

0,00

417

731

218

234

91,4

114

879

87,7

061

3290

,23

- A

s Pr

evio

usly

Rep

orte

d41

789

524

851

468

,16

326

326

0,00

418

221

248

839

68,0

714

990

64,8

161

3667

,03

- P

rior

Yea

r A

djus

tmen

t(4

90)

67-8

34,5

9-

-0,

00(4

90)

67-8

34,5

9-0

0-8

20,3

5-0

0-8

30,0

5-

AC

133

Tra

nsiti

on A

djus

tmen

t-

(30

672)

100,

00-

-0,

00-

(30

672)

100,

00-

-11

100,

00-

-410

0,00

Unr

ealis

ed G

ains

/(Lo

sses

) on

Re-

mea

sure

men

t of

Inve

stm

ents

328

984

218

272

50,7

2-

-0,

0032

898

421

827

250

,72

117,

0079

47,8

048

3249

,79

Tran

sfer

(to

)/fr

om In

com

e St

atem

ent

on

Dis

posa

l of I

nves

tmen

ts(1

652

7)(4

398)

275,

78-

-0,

00(1

652

7)(4

398)

275,

78-6

-226

8,49

-2-1

273,

46Tr

ansf

er (

to)/

from

Res

erve

s1

485

(188

6)17

8,72

--

0,00

148

5(1

886)

178,

721

-117

7,19

0-0

178,

23O

ther

(28

311)

(12

000)

135,

92-

-0,

00(2

831

1)(1

200

0)13

5,92

-10

-413

1,35

-4-2

134,

47

Bala

nces

at

the

End

of t

he Y

ear

703

037

417

895

68,2

332

632

60,

0070

336

241

822

168

,18

250

151

64,9

210

261

67,1

4

REV

ALU

ATIO

N R

ESER

VE

(PRO

PERT

Y,PL

AN

T A

ND

EQ

UIP

MEN

T)

Bala

nces

at

the

Begi

nnin

g of

the

Yea

r13

853

732

989

,02

--

0,00

1385

37

329

89,0

25

385

,36

21

87,8

6- A

s Pr

evio

usly

Rep

orte

d6

399

732

9-1

2,68

--

0,00

639

97

329

-12,

682

3-1

4,37

11

-13,

22-

Prio

r Yea

r A

djus

tmen

t7

453

-N

/A-

-0,

007

453

-N

/A3

-N

/A1

-N

/AU

nrea

lised

Gai

ns/(

Loss

es)

on R

e-m

easu

rem

ent

of P

rope

rty

Plan

t an

d Eq

uipm

ent

1263

7(9

29)

1459

,85

--

0,00

1263

7(9

29)

1459

,85

4-0

1433

,47

2-0

1451

,44

Tran

sfer

(to

)/fr

om In

com

e St

atem

ent

on

Dis

posa

l of P

rope

rty

Plan

t an

d Eq

uipm

ent

--

0,00

--

0,00

--

0,00

--

0,00

--

0,00

Tran

sfer

(to

)/fr

om R

eser

ves

--

0,00

--

0,00

--

0,00

--

0,00

--

0,00

Oth

er(5

612)

-N

/A-

-0,

00(5

612)

-N

/A-2

-N

/A-1

-N

/A

Bala

nces

at

the

End

of t

he Y

ear

2087

86

399

226,

25-

-0,

0020

878

639

922

6,25

72

219,

923

122

4,23

RES

ERV

ES S

ET A

SID

E FO

R S

PEC

IFIC

PU

RPO

SES

Bala

nces

at

the

Begi

nnin

g of

the

Yea

r48

756

244

152

410

,43

--

0,00

487

562

441

524

10,4

317

316

08,

2971

649,

74- A

s Pr

evio

usly

Rep

orte

d48

756

243

870

911

,14

--

0,00

487

562

438

709

11,1

417

315

98,

9871

6410

,45

- Pr

ior Y

ear

Adj

ustm

ent

-2

815

-100

,00

--

0,00

-2

815

-100

,00

-1

-100

,00

-0

-100

,00

Tran

sfer

(to

)/fr

om R

eser

ves

(439

8)(3

383

1)-8

7,00

--

0,00

(439

8)(3

383

1)-8

7,00

-2-1

2-8

7,25

-1-5

-87,

08O

ther

6721

179

869

-15,

85-

-0,

0067

211

7986

9-1

5,85

2429

-17,

4810

12-1

6,37

Bala

nces

at

the

End

of t

he Y

ear

550

375

487

562

12,8

8-

-0,

0055

037

548

756

212

,88

195

177

10,6

980

7112

,19


ANNEXURE E5

Cons

olid

ated

sta

tem

ent

of c

hang

es i

n fu

nds

and

rese

rves

for

the

year

end

ed 3

1 De

cem

ber

2004

Consolidated statement of changes in funds and reserves

OT

HER

RES

ERV

ESBa

lanc

es a

t th

e Be

ginn

ing

of t

he Y

ear

409

420

364

382

12,3

631

331

30,

0040

973

336

469

512

,35

146

132

10,1

759

5311

,66

- As

Prev

ious

ly R

epor

ted

436

439

364

382

19,7

831

331

30,

0043

675

236

469

519

,76

155

132

17,4

463

5319

,02

- Pr

ior Y

ear

Adj

ustm

ent

(27

019)

-N

/A-

-0,

00(2

701

9)-

N/A

-10

-N

/A-4

-N

/ATr

ansf

er (

to)/

from

Res

erve

s55

832

1483

927

6,24

--

0,00

5583

214

839

276,

2420

526

8,94

82

273,

91O

ther

2755

757

218

-51,

84-

-0,

0027

557

5721

8-5

1,84

1021

-52,

774

8-5

2,14

Bala

nces

at

the

End

of t

he Y

ear

492

808

436

439

12,9

231

331

30,

0049

312

143

675

212

,91

175

158

10,7

271

64,

12,2

1

REG

ISTE

RED

SC

HEM

ESBA

RGA

ININ

G C

OU

NC

IL S

CH

EMES

CO

NSO

LID

ATED

Per A

vera

ge M

embe

rPe

r Ave

rage

Ben

efic

iary

2004

2003

%20

0420

03%

2004

2003

%20

0420

03%

2004

2003

%R’

000

R’00

0C

hang

eR’

000

R’00

0C

hang

eR’

000

R’00

0C

hang

eR

RC

hang

eR

RC

hang

e


ANNEXURE E5

Cons

olid

ated

sta

tem

ent

of c

hang

es i

n fu

nds

and

rese

rves

for

the

year

end

ed 3

1 De

cem

ber

2004

Consolidated statement of changes in funds and reserves

MEM

BERS

DEP

END

AN

TSBE

NEF

ICIA

RIES

2004

2003

%20

0420

03%

2004

2003

%C

hang

eC

hang

eC

hang

eR

egis

tere

d S

chem

es2

716

264

268

805

51,

053

946

299

398

374

6-0

,94

666

256

36

671

801

-0,1

4-

Ope

n Sc

hem

es1

924

343

188

372

82,

162

830

960

283

506

9-0

,14

475

530

34

718

797

0,77

- R

estr

icte

d Sc

hem

es79

192

180

432

7-1

,54

111

533

91

148

677

-2,9

01

907

260

195

300

4-2

,34

Bar

gain

ing

Co

unci

l Sch

emes

117

058

114

760

2,00

136

045

138

125

-1,5

125

310

325

288

50,

09

TO

TA

L M

EM

BE

RS

HIP

283

332

22

802

815

1,09

408

234

44

121

871

-0,9

66

915

666

692

468

6-0

,13

Reg

iste

red

Sch

emes

270

173

62

665

280

1,37

395

153

83

986

882

-0,8

96

653

275

665

216

20,

02-

Ope

n Sc

hem

es1

900

692

185

981

62,

202

816

744

283

352

6-0

,59

471

743

64

693

342

0,51

- R

estr

icte

d Sc

hem

es80

104

480

546

4-0

,55

113

479

51

153

356

-1,6

11

935

838

195

882

0-1

,17

Bar

gain

ing

Co

unci

l Sch

emes

113

900

9574

718

,96

130

932

107

562

21,7

324

483

220

330

920

,42

AV

ER

AG

E M

EM

BE

RS

HIP

281

563

62

761

027

1,98

408

247

04

094

445

-0,2

96

898

107

685

547

10,

62

MEM

BER

SHIP

PER

PRO

VIN

CE

as a

t D

ecem

ber

% o

f tot

al%

of t

otal

% o

f tot

alG

aute

ng1

092

200

38,5

5%1

487

204

36,4

3%2

579

404

37,3

0%Li

mpo

po98

047

3,46

%18

161

14,

45%

279

658

4,04

%M

pum

alan

ga16

641

85,

87%

287

790

7,05

%45

420

86,

57%

Nor

th W

est

124

799

4,40

%18

813

14,

61%

312

930

4,52

%Fr

ee S

tate

130

568

4,61

%18

825

44,

61%

318

822

4,61

%K

wa-

Zul

u N

atal

417

706

14,7

4%61

089

414

,96%

102

860

014

,87%

Wes

tern

Cap

e50

858

517

,95%

685

300

16,7

9%1

193

885

17,2

6%Ea

ster

n C

ape

234

735

8,28

%36

109

18,

85%

595

826

8,62

%N

orth

ern

Cap

e60

264

2,13

%92

069

2,26

%15

233

32,

20%

Ave

rage

No

of D

epen

dant

s pe

r M

embe

r1,

451,

48O

vera

ll Pe

nsio

ner

Rat

io6,

66%

5,90

%A

vera

ge A

ge32

,02


ANNEXURE F5

Cons

olid

ated

mem

bers

hip

anal

ysis

as a

t 31

Dec

embe

r 20

04Consolidated membership analysis

PRIV

ATE

FAC

ILIT

IES

Num

ber

of:

Adm

issi

ons

to H

ospi

tals

190,

4321

6,04

197,

95A

dmis

sion

s fo

r PM

B in

ho

spita

ls26

,69

33,5

728

,71

Adm

issi

ons

to d

ay c

linic

s an

d op

erat

ing

thre

atre

s7,

6427

,52

13,4

8Be

nefic

iari

es a

dmitt

ed

to IC

U7,

855,

477,

15Be

nefic

iari

es a

dmitt

ed

to h

igh

care

war

d12

,00

7,78

10,7

6Be

nefic

iari

es a

dmitt

ed

to g

ener

al w

ard

67,3

310

8,33

79,3

7Pr

egna

ncie

s6,

786,

596,

72Bi

rths

7,79

5,12

7,01

Live

bir

ths

5,06

2,47

4,30

Cae

sare

an s

ectio

ns5,

615,

595,

60Be

nefic

iari

es a

dmitt

ed

for

dial

ysis

0,55

0,41

0,51

Sel

ecte

d m

edic

al in

vest

igat

ions

Num

ber

of:

Bene

ficia

ries

rec

eivi

ng

MR

I and

CT

sca

ns9,

8213

,35

10,8

6M

RI a

nd C

T s

cans

ad

min

iste

red

15,6

620

,00

16,9

4Be

nefic

iari

es r

ecei

ving

PE

T S

cans

0,00

0,61

0,18

PET

Sca

ns a

dmin

iste

red

0,00

1,34

0,40

Bene

ficia

ries

rec

eivi

ng

Ang

iogr

ams

2,97

2,60

2,86

Ang

iogr

ams

adm

inis

tere

d6,

185,

676,

03

Pre

vent

ativ

e H

ealt

hN

umbe

r of

:M

amm

ogra

ms

adm

inis

tere

d4,

376,

074,

87Pa

p sm

ears

adm

inis

tere

d47

,69

20,9

739

,84

Mo

rtal

ity

Num

ber

of d

eath

s1,

352,

021,

55

PUBL

IC F

AC

ILIT

IES

Num

ber

of:

Adm

issi

ons

to h

ospi

tals

9,23

17,0

911

,54

Adm

isso

ns fo

r PM

B in

ho

spita

ls0,

663,

431,

48Be

nefic

iari

es a

dmitt

ed

to IC

U0,

030,

110,

05Be

nefic

iari

es a

dmitt

ed

to h

igh

care

war

d0,

040,

030,

03Be

nefic

iari

es a

dmitt

ed

to g

ener

al w

ard

3,21

7,15

4,37

Preg

nanc

ies

0,07

0,12

0,09

Birt

hs0,

130,

100,

12Li

ve b

irth

s0,

020,

060,

03

PRIV

ATE

PRO

VID

ERS

Ben

efic

iari

es v

isit

ing

a p

rovi

der

at le

ast

once

a y

ear

Pri

vate

pro

vide

rsBe

nefic

iari

es v

isiti

ng a

G

P at

leas

t on

ce a

yea

r71

0,99

811,

3174

0,46

Bene

ficia

ries

vis

iting

a

Den

tist

at le

ast

once

a

year

260,

6533

5,59

282,

66Be

nefic

iari

es v

isiti

ng a

Pr

ivat

e N

urse

at

leas

t on

ce a

yea

r4,

918,

155,

87

Med

ical

Spe

cial

ists

Der

mat

olog

ist

14,6

930

,26

19,1

6O

bste

tric

s &

G

ynae

colo

gist

35,6

377

,94

47,7

8Pu

lmon

olog

ist

2,38

5,01

3,13

Phys

icia

n27

,11

60,4

836

,70

Gas

troe

nter

olog

ist

2,78

5,23

3,48

Neu

rolo

gist

4,70

10,3

76,

33C

ardi

olog

ist

9,19

17,3

611

,54

Psyc

hiat

rist

6,04

17,1

39,

23M

edic

al O

ncol

ogis

t0,

531,

230,

73N

euro

-Sur

geon

4,68

10,9

56,

48N

ucle

ar M

edic

ine

1,37

2,42

1,67

Oph

thal

mol

ogis

t19

,31

38,3

824

,79

Ort

hopa

edic

Sur

geon

20,5

844

,24

27,3

8O

torh

inol

aryn

golo

gist

14,8

733

,26

20,1

5Pa

edia

tric

ian

20,4

548

,78

28,5

9Pa

edia

tric

Car

diol

ogis

t0,

511,

020,

65Sp

ecia

list

Phys

ical

M

edic

ine

0,19

0,36

0,24

Plas

tic R

econ

stru

ctiv

e Su

rgeo

n2,

264,

752,

97Su

rgeo

n22

,42

47,6

429

,67

Tho

raci

c Su

rgeo

n1,

462,

971,

89U

rolo

gist

10,0

322

,00

13,4

7

Clin

ical

Sup

port

Spe

cial

ists

Ana

esth

etis

t41

,75

88,8

155

,27

Path

olog

ist

151,

1332

0,20

199,

71R

adio

logi

st94

,57

208,

3212

7,26

Rad

ioth

erap

ist

2,77

6,06

3,71

Labo

rato

ry T

echn

olog

ist

0,20

1,02

0,43

Oth

er3,

2119

,12

7,78

Den

tal S

peci

alis

tsM

axill

a,Fa

cial

& O

ral

Surg

eons

4,48

10,2

66,

14O

ral P

atho

logi

st0,

070,

120,

09O

rtho

dont

ist

4,22

12,2

16,

52Pe

riod

ontis

t0,

892,

281,

29Pr

osth

odon

tist

0,57

1,58

0,86

PRIV

ATE

PRO

VID

ERS

Ben

efic

iari

es v

isit

ing

a p

rovi

der

at le

ast

once

a y

ear

Alli

ed a

nd S

uppo

rt H

ealt

h P

rofe

ssio

nals

Med

ical

Tec

hnol

ogis

t15

,81

9,85

18,1

9Po

diat

rist

6,43

5,97

6,61

Opt

omet

rist

167,

1618

7,08

159,

22Ph

ysio

ther

apis

t85

,84

82,7

087

,09

Ort

hopt

ist

0,25

0,20

0,27

Spee

ch T

hera

pist

9,37

8,97

9,52

Psyc

holo

gist

29,0

728

,30

29,3

8O

ccup

atio

nal T

hera

py6,

475,

956,

67Pr

ivat

e N

urse

5,45

5,69

5,35

Die

ticia

n8,

638,

648,

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ANNEXURE G5

Uti

lisat

ion

of s

ervi

ces

for

the

year

end

ed 3

1 De

cem

ber

2004

Utilisation of services

UTI

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ANNEXURE G5

Uti

lisat

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of s

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for

the

year

end

ed 3

1 De

cem

ber

2004

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OPE

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ANNEXURE H5

Anal

ysis

of

all

bene

fits

pai

dfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20

04Analysis of all benefits paid

Note

s:•

PAB

PM

= p

er a

vera

ge b

enef

icia

ry p

er m

on

th

TO

TA

L H

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ON

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DAT

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BPM

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ANNEXURE H5

Anal

ysis

of

all

bene

fits

pai

dfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20

04Analysis of all benefits paid

OPE

NRE

STRI

CTE

DO

PEN

REST

RIC

TED

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AIN

ING

CO

UN

CIL

SC

HEM

ESC

ON

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DAT

EDPA

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SCH

EMES

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tota

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ANNEXURE I5

Anal

ysis

of

risk

ben

efit

s pa

idfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20

04Analysis of risk benefits paid

TO

TA

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ry p

er m

on

th


ANNEXURE I5

Anal

ysis

of

risk

ben

efit

s pa

idfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20

04Analysis of risk benefits paid

GE

NE

RA

L P

RA

CT

ITIO

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RS

548

431

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s:•

Glo

bal

/ p

er d

iem

ho

spit

al f

ee a

nd

cap

itat

ed p

rim

ary

care

are

no

t ap

pli

cab

le i

n t

his

sch

edu

le•

PAB

PM

= p

er a

vera

ge b

enef

icia

ry p

er m

on

th


ANNEXURE J5

Anal

ysis

of

savi

ngs

bene

fits

pai

dfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20

04Analysis of savings benefits paid

RE

GIS

TE

RE

D S

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– O

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003

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nt M

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iety

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n (N

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r M

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chem

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iety

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Ref

.N

ame

of M

edic

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chem

eM

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rsBe

nefic

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o.of

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ssG

ross

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inist

ratio

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anag

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are:

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end-

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trib

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nses

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r BS)

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BPM

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000

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ANNEXURE K5

Deta

iled

fina

ncia

l re

sult

s: r

egis

tere

d sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20

04Detailed financial results: registered schemes

Ref

.N

ame

of M

edic

al S

chem

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embe

rsBe

nefic

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inist

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r BS)

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--

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69

329

931

113

246

4289

942

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55,5

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Med

ical

Aid

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1324

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5610

155

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99

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2557

516

430

1644

721

637

6432

364

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63,3

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24SA

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al A

id S

chem

e3

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22,

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117,

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315

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111

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111

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81,

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815

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737

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i Med

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109

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Siem

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Med

ical

Sch

eme

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46

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1,31

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13

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ican

Pol

ice

Serv

ice

Med

ical

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eme

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LMED

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629

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933

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er B

rand

s M

edic

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4,75

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88,

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944

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hem

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00,

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66

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431

354

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485

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ANNEXURE K5

Deta

iled

fina

ncia

l re

sult

s: r

egis

tere

d sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20


Ref

.N

ame

of M

edic

al S

chem

eM

embe

rsBe

nefic

iaries

No.

ofG

ross

Gro

ss A

dmin

istra

tion

Man

aged

Car

e:Br

oker

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tN

ettC

laim

sG

ross

Net

tSu

rplu

s/N

ett

Net

t Ass

ets

Net

t So

lvenc

yN

o.D

epen

d-C

ontr

ibut

ions

Ex

pens

es (R

ISK +

PMSA

) M

anag

emen

t Ser

vices

Fees

Rein

sur-

Incu

rred

:U

nder

writ

ing

Und

erw

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g(D

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t)Su

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s/(M

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sets

per

Ratio

ants

per

ance

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t Con

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sults

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latio

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sults

trib

utio

nsO

pera

tions

per B

S)29

PABP

MAs

% of

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%of

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M31

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GC

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000

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34U

med

958

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1,59

223

624

747

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rsity

of N

atal

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--

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49,2

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82U

nive

rsity

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he W

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rand

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chem

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984

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--

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ical

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med

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(431

)(4

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A

id S

chem

e5

679

1513

51,

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174

26

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20,

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Note

s:a

Dra

ft A

nn

ual

Fin

anci

al S

tate

men

ts w

ere

sub

mit

ted

.b

An

en

cum

ber

ed a

sset

was

exc

lud

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n t

he

calc

ula

tio

n o

f th

e so

lven

cy r

atio

.c

A s

ub

ord

inat

ed l

oan

was

in

clu

ded

in

th

e ca

lcu

lati

on

of

the

solv

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rat

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dTh

e so

lven

cy r

atio

has

bee

n r

esta

ted

by

rem

ovin

g th

e in

clu

sio

n o

f th

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ecia

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vern

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ent

sub

sid

ised

pen

sio

ner

gro

up

co

ntr

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tio

ns.

eTh

e sc

hem

e w

as r

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d d

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2000

, an

d a

ph

ase-

in s

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rat

io o

f 22

%ap

pli

es.

fTh

e sc

hem

e w

as r

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d d

uri

ng

2001

, an

d a

ph

ase-

in s

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ency

rat

io o

f 17

,5%

app

lies

.g

The

sch

eme

was

reg

iste

red

du

rin

g 20

02, a

nd

a p

has

e-in

so

lven

cy r

atio

of

13,5

%ap

pli

es.

hTh

e sc

hem

e w

as r

egis

tere

d d

uri

ng

2003

, an

d a

ph

ase-

in s

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ency

rat

io o

f 10

%ap

pli

es.

iTh

e sc

hem

e w

as r

egis

tere

d d

uri

ng

2004

, an

d a

ph

ase-

in s

olv

ency

rat

io o

f 10

% w

ill

app

ly t

o t

he

sch

eme

fro

m D

ecem

ber

200

5.j

Myh

ealt

h a

mal

gam

ated

wit

h O

xyge

n w

ith

eff

ect

fro

m 1

Ju

ly 2

004.

kA

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ogo

ld a

mal

gam

ated

wit

h D

isco

very

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lth

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om

1 J

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e 20

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h S

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cor

Hea

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Pla

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fro

m 1

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•P

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Med

ical

Sav

ings

Acc

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nt

•G

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Co

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BP

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Per

Ave

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Ben

efic

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S =

Bal

ance

Sh

eet


ANNEXURE K5

Deta

iled

fina

ncia

l re

sult

s: r

egis

tere

d sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20


RE

GIS

TE

RE

D S

CH

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lCar

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N/A

N/A

(331

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j12

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Med

ical S

chem

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Med

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ty (C

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7638

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268

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2,10

110,9

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52Co

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unity

Med

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chem

e (C

OM

MED

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Disc

over

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Med

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chem

e15

1062

313

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1296

5892

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580

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348

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2010

294

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Med

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-293

788

8095

016

5106

4460

1482

,4680

,1412

53Xs

trat

a M

edica

l Aid

Sch

eme

1135

911

263

166

402

6288

06

487

465

550

419

4641

19

370

343

870

9370

151

5252

033

641

2170

755

2890

1911

5150

,6634

,52

SUB-

TOTA

L –

Regis

tere

d Re

strict

ed S

chem

es19

3583

919

5882

0-1

,1714

7031

9213

9060

446

633

592

712

3639

6311

6343

836

532

495

813

2594

512

5177

86

5753

784

5782

468

2686

524

4435

3496

2757

,9549

,57

TOTA

L RE

GIS

TERE

D S

CH

EMES

6653

275

6652

162

0,02

5153

1439

4803

1615

764

560

27

4080

8601

3822

0656

751

147

97

6231

718

5609

795

1178

7011

1850

2620

1375

5777

34,5

2777

2062

3536

,6129

,30

Ref.

Nam

e of

Med

ical S

chem

eBe

nefic

iarie

sG

ross

Con

trib

utio

n In

com

e N

ett C

laim

s In

curr

edG

ross

Adm

inist

ratio

n Ex

pens

es

Year

-End

Res

erve

Pos

ition

So

lvenc

y N

o.(G

CI)

(incl

PMSA

Clai

ms)

(Incl

PMSA

& M

anag

ed C

are)

(per

Reg

ulat

ion

29)

Ratio

Aver

age

Aver

age

%20

0420

03%

PABP

M%

2004

2003

%PA

BPM

%20

0420

03%

PABP

M%

2004

2003

%PB

PB%

2004

2003

2004

2003

Grow

thR’

000

R’00

0Gr

owth

2004

2003

Grow

thR’

000

R’00

0Gr

owth

2004

2003

Grow

thR’

000

R’00

0Gr

owth

2004

2003

Grow

thR’

000

R’00

0Gr

owth

2004

2003

Grow

th%

%R

RR

RR

RR

R

Note

s:a

Dra

ft A

nn

ual

Fin

anci

al S

tate

men

ts w

ere

sub

mit

ted

.b

An

en

cum

ber

ed a

sset

was

exc

lud

ed i

n t

he

2004

cal

cula

tio

n o

f th

e so

lven

cy r

atio

.c

An

en

cum

ber

ed a

sset

was

exc

lud

ed i

n t

he

2003

cal

cula

tio

n o

f th

e so

lven

cy r

atio

.d

A s

ub

ord

inat

ed l

oan

was

in

clu

ded

in

th

e ca

lcu

lati

on

of

the

solv

ency

rat

io.


ANNEXURE L5

Deta

iled

fina

ncia

l in

form

atio

n: r

egis

tere

d sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20


eTh

e so

lven

cy r

atio

has

bee

n r

esta

ted

by

rem

ovin

g th

e in

clu

sio

n o

f th

e sp

ecia

l go

vern

-m

ent

sub

sid

ized

pen

sio

ner

gro

up

co

ntr

ibu

tio

ns.

fTh

e sc

hem

e w

as r

egis

tere

d d

uri

ng

2000

, an

d a

ph

ase-

in s

olv

ency

rat

io o

f 22

%ap

pli

es.

gTh

e sc

hem

e w

as r

egis

tere

d d

uri

ng

2001

, an

d a

ph

ase-

in s

olv

ency

rat

io o

f 17

,5%

app

lies

.h

The

sch

eme

was

reg

iste

red

du

rin

g 20

02, a

nd

a p

has

e-in

so

lven

cy r

atio

of

13,5

%ap

pli

es.

iTh

e sc

hem

e w

as r

egis

tere

d d

uri

ng

2003

, an

d a

ph

ase-

in s

olv

ency

rat

io o

f 10

%ap

pli

es.

jTh

e sc

hem

e w

as r

egis

tere

d d

uri

ng

2004

, an

d a

ph

ase-

in s

olv

ency

rat

io o

f 10

% w

ill

app

ly t

o t

he

sch

eme

fro

m D

ecem

ber

200

5.k

Myh

ealt

h a

mal

gam

ated

wit

h O

xyge

n w

ith

eff

ect

fro

m 1

Ju

ly 2

004.

lA

ngl

ogo

ld a

mal

gam

ated

wit

h D

isco

very

Hea

lth

wit

h e

ffec

t fr

om

1 J

un

e 20

04.

mB

illm

ed a

mal

gam

ated

wit

h S

aman

cor

Hea

lth

Pla

n w

ith

eff

ect

fro

m 1

Ju

ly 2

004.

•P

MSA

= P

erso

nal

Med

ical

Sav

ings

Acc

ou

nt

•G

CI

= G

ross

Co

ntr

ibu

tio

n I

nco

me

•PA

BP

M =

Per

Ave

rage

Ben

efic

iary

Per

Mo

nth

•P

B =

Per

Ben

efic

iary

•Th

ere

are

no

200

4 fi

gure

s fo

r th

e co

lou

r co

ded

sch

emes

du

e to

:–

Sch

emes

liq

uid

atin

g d

uri

ng

the

year

(H

igh

veld

fu

rnis

hed

th

e O

ffic

e w

ith

man

-ag

emen

t ac

cou

nts

fo

r th

e 20

03 f

inan

cial

yea

r).

The

foll

owin

g sc

hem

es a

mal

gam

ated

in

200

4:•

All

care

wit

h N

BC

wit

h e

ffec

t fr

om

1 J

anu

ary

2004

.•

An

glo

gold

wit

h D

isco

very

Hea

lth

wit

h e

ffec

t fr

om

1 J

un

e 20

04.

•M

yhea

lth

wit

h O

xyge

n w

ith

eff

ect

fro

m 1

Ju

ly 2

004.

•B

illm

ed w

ith

Sam

anco

r w

ith

eff

ect

fro

m 1

Ju

ly 2

004.

•Th

ere

are

no

200

3 fi

gure

s fo

r th

e co

lou

r co

ded

sch

emes

du

e to

:–

Sch

emes

reg

iste

rin

g d

uri

ng

2004

. Th

e so

lven

cy r

atio

is

no

t d

irec

tly

com

par

able

to t

hat

of

oth

er s

chem

es.


ANNEXURE L5

Deta

iled

fina

ncia

l in

form

atio

n: r

egis

tere

d sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20


1139

Om

nihea

lth34

811

7289

8-5

246

257

8888

338

0375

6463

39-4

168

560

613

3393

0951

2389

-34

611

480

2758

362

2082

27-7

215

3210

519

5-4

6(6

93)

1173

3-1

06-2

016

1-1

12-0

,181,8

27,9

21,6

95,2

312

15O

xyge

n20

0498

1192

6068

1655

7611

6480

9459

9960

6837

5647

643

410

7936

1846

4522

7139

933

220

1681

1510

9010

5418

1885

788

1538

3215

5623

-176

713

05-4

116

,2625

,6415

,4310

,974,1

211

70N

BC M

edica

l Sch

eme

1751

915

524

1318

245

1599

320

6886

1690

0822

945

881

716

3882

1306

6925

749

681

1028

428

2250

326

1413

130

117

1136

769

2482

548

2099

1599

3117

,7714

,694,8

9-1

,112,5

215

76Lib

erty

Med

ical S

chem

e94

833

1034

22-8

9550

610

7105

7648

1972

0870

666

756

119

5826

9958

8487

-150

845

811

1128

5010

6115

615

1598

8319

1589

4872

458

119

1676

701

139

20,78

10,05

7,99

7,16

3,45

1125

Disc

over

y H

ealth

M

edica

l Sch

eme

1564

874

1427

167

1015

1062

313

7720

412

9658

9210

9989

7218

715

666

794

7958

079

7444

119

523

483

821

9750

819

1172

115

1717

121

116

530

6285

116

5605

785

1957

1160

6923

,6215

,067,3

32,5

81,7

011

66N

atio

nal I

ndep

ende

nt

Med

ical A

id S

ociet

y (N

IMAS

)36

698

3375

39

3566

933

241

2589

3522

2230

1760

555

79

2268

4919

5525

1653

049

08

2151

816

129

338

750

4024

5261

940

645

2914

3412

0419

20,32

18,29

12,72

12,13

16,74

1575

Reso

lutio

n H

ealth

M

edica

l Sch

eme

7681

961

713

2467

315

5292

138

5918

2775

2939

478

437

920

8497

1641

0227

258

258

012

4100

7908

557

3228

154

125

2395

622

5448

875

1245

883

4124

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,6316

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,1812

,1712

85Pr

otec

tor H

ealth

7035

691

876

-23

8484

382

938

5664

9253

3496

655

653

64

5196

3547

3098

1051

047

57

6972

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864

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(384

9)21

595

-118

-55

235

-123

-0,68

4,05

7,42

25,45

27,71

1587

Path

finde

r Med

ical

Sche

me

4862

1684

189

2512

2022

1229

868

1980

408

281

4570

7657

6423

235

238

-142

7734

1325

3550

142

141

133

N/A

N/A

7N

/AN

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70,0

0-1

2,56

N/A

N/A

1546

Phar

os M

edica

l Plan

1876

216

170

1617

812

1578

813

3279

1039

6928

624

549

1410

6789

8376

927

500

442

1325

392

1779

943

1917

119

9426

2044

317

287

1810

9010

692

15,34

16,63

13,49

13,55

11,19

1464

Sure

med

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lth72

6978

43-7

6909

7251

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941

897

1759

248

223

3423

028

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332

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1159

313

714

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2433

140

158

-11

8357

4332

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817

,0110

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87M

unim

ed11

9484

1157

283

1169

8199

267

1012

616

7938

6628

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666

887

5740

6739

3930

624

566

1014

6380

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0411

1417

104

110

-610

6633

1106

72-4

892

956

-710

,5313

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,9022

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67N

atio

nal M

edica

l Plan

(N

MP)

1417

4815

0341

-614

4491

1514

2812

9219

312

1641

96

745

669

1110

5611

710

0869

75

609

555

1017

8222

1703

565

1414

103

9410

2801

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0829

719

7717

3514

21,68

21,44

20,93

17,06

18,50

1589

Baym

ed40

03N/

AN/

A40

03N/

A30

09N/

AN/

A63

N/A

N/A

2890

N/A

N/A

60N/

AN/

A45

0N/

AN/

A15

N/A

9N/

AN/

A(3

31)

N/A

N/A

-83

N/A

N/A

-10,9

9N/

AN/

AN/

AN/

A15

86Xp

ress

Car

e M

edica

l Sc

hem

e24

325

2540

6-4

2580

520

771

1222

2877

953

5739

531

326

9481

853

900

7630

621

642

2574

716

582

5521

2183

6725

1407

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655

357

953

78

11,52

17,52

16,60

0,00

N/A

1162

Glo

bal H

ealth

5766

564

725

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6233

047

715

4781

7135

7262

3463

962

42

4365

8731

8172

3758

455

65

5834

939

197

4912

1178

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217

0914

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20,61

26,98

28,68

22,47

19,36

1147

Telem

ed58

724

5172

714

6000

153

826

6769

6754

7823

2494

084

811

6390

4650

9871

2588

878

912

4293

741

707

36

860

65-8

1597

5914

9187

727

2128

84-6

23,60

27,23

26,18

24,83

16,89

Mov

emen

t in

the

solv

ency

pos

ition

s of o

pen

med

ical

sche

mes

that

ach

ieve

d 25

% as

at D

ecem

ber

2004

but w

ere

prev

ious

ly b

elow

the

pres

crib

ed le

vels

1202

Fedh

ealth

1422

4714

2384

014

0713

1532

3911

5021

111

2317

52

681

611

1287

4461

8538

582

518

464

1218

8258

1909

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111

104

729

6465

2531

8317

2084

1778

1725

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70,3

712

52Be

stmed

Med

ical S

chem

e82

284

7415

111

7937

667

475

6444

2851

9821

2467

764

25

4742

1639

8979

1949

849

31

8522

459

978

4213

1289

7421

2060

1211

3864

8125

0415

3663

31,97

21,90

13,08

6,93

-1,13

1577

Ingw

e H

ealth

Plan

3322

834

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054

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713

2539

1388

71-5

368

335

1099

556

8745

314

276

211

3138

664

3344

116

2924

107

8133

4280

744

795

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8812

910

32,30

32,26

16,63

9,22

6,74

1422

Topm

ed M

edica

l Sch

eme

3508

342

415

-17

3603

645

375

3273

7437

8884

-14

757

696

926

8975

2903

71-7

622

533

1740

393

4394

8-8

1212

9381

1612

4447

9658

229

3547

2277

5638

,0125

,497,6

71,8

91,0

511

40M

edsh

ield

Med

ical

Sche

me

1990

7025

0642

-21

2182

1026

1881

1365

338

1537

838

-11

521

489

787

1958

9384

17-7

333

299

1233

7507

3937

75-1

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2612

912

53

5532

0731

6745

7527

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040

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16,3

1-0

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penp

lan M

edica

l Sc

hem

e41

933

4942

9-1

544

279

5382

436

2027

3965

48-9

681

614

1131

4048

3217

27-2

591

498

1952

642

5782

0-9

1515

9990

1115

8171

1480

797

3772

2996

2643

,6937

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91,4

414

46Se

lfmed

Med

ical S

chem

e32

138

3554

5-1

033

299

3868

725

9059

2781

93-7

648

599

821

4441

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48-3

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1235

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4-9

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9085

611

6706

9120

428

3631

2566

4245

,0532

,7820

,8413

,797,8

011

41Sp

ectr

amed

2002

2415

8041

2717

6225

1365

9910

3064

869

9750

4748

742

714

7095

9156

7115

2533

634

6-3

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8996

565

6315

1474

5926

2652

1497

726

171

1325

618

114

25,73

13,97

11,34

9,47

10,01

1506

Med

imed

Med

ical

Sche

me

1272

497

1631

1258

195

5270

291

4854

345

466

423

1052

854

3660

244

350

319

1066

0346

2943

910

4440

831

806

1986

260

2500

2044

2245

,2540

,9225

,2810

,6112

,7710

21M

erid

ian H

ealth

4289

1122

6-6

252

2512

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5404

012

3901

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862

825

444

745

8774

9-4

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458

422

6667

1507

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06

3867

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936

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771

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0,24

1512

Bonit

as M

edica

l Aid

Fund

5275

7565

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5645

5466

8780

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4517

863

-14

573

563

230

0635

437

8041

6-2

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447

1-6

5051

5445

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1113

1075

5732

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7170

1769

2291

1101

108

31,11

15,87

9,49

16,71

18,13

1486

MSP

Sizw

e M

edica

l Sc

hem

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65-6

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154

815

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9125

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333

,6218

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,02

Ref.

Nam

e of

Med

ical S

chem

eBe

nefic

iarie

sG

ross

Con

trib

utio

n In

com

e N

ett C

laim

s In

curr

edG

ross

Non

-Hea

lth E

xpen

ses

Year

End

Res

erve

Pos

ition

So

lvenc

y N

o.(G

CI)

(incl

PMSA

Clai

ms)

(incl

PMSA

)(P

er R

egul

atio

n 29

)Ra

tio%

%%

%%

%As

As%

%%

2004

Aver

ageAv

erage

2004

2003

2004

PABP

M20

0420

0420

0320

04PA

BPM

2004

2004

2003

2004

%of

%of

PABP

M20

0420

0420

0320

04PB

PB20

0420

0420

0320

0220

0120

0031

/12/20

0431

/12/20

03Gr

owth

2004

2003

R’000

R’000

Grow

th20

0420

03Gr

owth

R’000

R’000

Grow

th20

0420

03Gr

owth

R’000

R’000

Grow

thGC

IGC

I200

420

03Gr

owth

R’000

R’000

Grow

th20

0420

03Gr

owth

25,0%

22,0%

17,50

%13

,50%

10%

RR

RR

2004

2003

RR

RR

Mov

emen

t in

the

solv

ency

pos

ition

s of o

pen

med

ical

sche

mes

that

did

not

ach

ieve

25%

as a

t Dec

embe

r 20

04

Note

s:Sc

hem

es p

lace

d u

nd

er c

lose

mo

nit

ori

ng

du

rin

g th

e 20

00 y

ear

Sch

emes

pla

ced

un

der

clo

se m

on

ito

rin

g d

uri

ng

the

2001

yea

rSc

hem

es p

lace

d u

nd

er c

lose

mo

nit

ori

ng

du

rin

g th

e 20

02 y

ear

Sch

emes

pla

ced

un

der

clo

se m

on

ito

rin

g d

uri

ng

the

2003

yea

rSc

hem

es p

lace

d u

nd

er c

lose

mo

nit

ori

ng

du

rin

g th

e 20

04 y

ear

Ple

ase

take

no

te t

hat

all

sch

emes

th

at a

mal

gam

ated

or

liq

uid

ated

wer

e re

mov

ed f

rom

the

tab

le

•P

MSA

= P

erso

nal

Med

ical

Sav

ings

Acc

ou

nt

•G

CI

= G

ross

Co

ntr

ibu

tio

n I

nco

me

•PA

BP

M =

Per

Ave

rage

Ben

efic

iary

Per

Mo

nth

•P

B =

Per

Ben

efic

iary


ANNEXURE M5

Mov

emen

t in

the

sol

venc

y po

siti

ons

of o

pen

med

ical

sch

emes

as a

t 31

Dec

embe

r 20

04Movement in the solvency positions of open medical schemes

RE

GIS

TE

RE

D S

CH

EM

ES

– O

PE

N15

89Ba

ymed

133

627

,10

133

627

,10

121

325

,61

637

N/A

0,44

183

--

--

-0,

1312

52Be

stm

ed M

edic

al S

chem

e5

998

3,40

781

0,44

4819

337

,09

1290

072

,62

0,46

302

937

748

43

957

746

254

53

236

7,80

1512

Boni

tas

Med

ical

Aid

Fun

d65

225

6,13

9185

68,

6331

068

837

,72

177

249

114,

080,

711

120

484

220

138

453

601

2805

664

651

537

84,

1510

34C

ape

Med

ical

Pla

n4

504

25,0

186

0,48

301

416

,10

500

011

9,98

0,95

4918

527

643

6645

716

530

-1

230

8,64

1048

Com

mer

cial

and

Indu

stri

al M

edic

al

Aid

Soc

iety

(C

IMA

S)7

603

34,0

66

041

27,0

66

367

31,4

02

500

92,1

60,

4191

595

165

915

870

682

1167

2-

14,0

615

52C

omm

unity

Med

ical

Aid

Sch

eme

(CO

MM

ED)

527

78,

666

819

11,1

914

590

30,2

312

000

103,

950,

8287

560

3440

743

086

-30

614

45,

5314

91C

ompc

are

Med

ical

Sch

eme

1071

714

,73

956

613

,15

1642

429

,12

1059

910

3,66

0,65

128

676

-98

42

388

--

7,50

1125

Dis

cove

ry H

ealth

Med

ical

Sch

eme

602

559

16,9

652

189

614

,69

358

489

13,8

040

350

811

1,28

0,66

214

017

42

019

169

--

--

5,27

1596

Eclip

se M

edic

al S

chem

e52

6,56

526,

5633

551

,97

455

N/A

2,32

865

--

--

-4,

3912

02Fe

dhea

lth67

758

21,5

072

160

22,9

015

277

6,38

6198

511

2,94

1,01

324

128

7156

950

227

110

823

879

512

2,69

1501

Free

Sta

te M

edic

al A

id S

chem

e31

5,66

-0,

0011

922

,73

105

0,00

0,76

900

554

--

-2

9,12

1554

Gen

esis

Med

ical

Sch

eme

161

0,56

330,

129

264

41,4

47

051

93,2

91,

3284

994

--

--

-12

,50

1561

Gen

-Hea

lth M

edic

al S

chem

e6

859

30,6

36

443

28,7

76

245

42,7

04

544

53,3

31,

2457

845

--

--

685

13,0

011

62G

loba

l Hea

lth28

625

21,8

529

303

22,3

725

637

21,4

318

000

111,

340,

6081

608

538

63

457

503

979

105

102

72,

3914

66G

ood

Hop

e M

edic

al A

id S

ocie

ty41

55,

67-

0,00

178

927

,31

630

32,6

60,

3229

101

-14

3-

692

3-

14,6

015

37H

osm

ed M

edic

al A

id S

chem

e19

936

12,1

714

169

8,65

2926

421

,39

8647

611

7,58

2,08

277

737

--

--

286

6,67

a15

77In

gwe

Hea

lth P

lan

385

510

,62

135

43,

7312

050

44,1

85

145

103,

930,

6259

625

--

--

-7,

1915

56K

waZ

ulu-

Nat

al M

edic

al A

id

Sche

me

496

2,76

245

113

,62

1021

671

,29

690

095

,18

1,58

8463

6-

531

8-

-68

19,4

215

76Li

bert

y M

edic

al S

chem

e4

286

2,05

409

81,

9612

579

7,88

3600

089

,22

0,95

172

867

9856

39

080

--

-4,

0815

36Li

fem

ed M

edic

al S

chem

e5

717

22,9

15

556

22,2

74

847

23,5

44

017

106,

000,

6430

583

-3

659

107

4-

-4,

8811

42M

edic

al E

xpen

ses

Dis

trib

utio

n So

ciet

y (M

EDS)

1461

224

,12

1370

122

,62

229

64,

528

000

104,

930,

5433

136

3899

628

824

--

-1,

3415

49M

edic

over

200

023

350

14,8

395

0,06

983

48,

7826

132

87,2

20,

8560

610

720

255

1456

433

231

-3

553

18,3

611

49M

edih

elp

141

379

19,5

728

571

3,96

115

443

18,3

565

520

98,6

00,

3558

615

7-

2378

517

992

-24

433

3,06

1506

Med

imed

Med

ical

Sch

eme

465

824

,19

433

022

,49

224

515

,51

360

986

,21

0,99

3445

4-

--

-22

7,82

1140

Med

shie

ld M

edic

al S

chem

e27

827

7,44

3480

99,

3117

009

571

,20

4109

697

,21

0,71

696

705

3983

3-

-12

621

419

10,1

410

21M

erid

ian

Hea

lth2

284

15,4

31

978

13,3

698

58,

043

155

93,3

91,

1211

295

2094

221

307

--

-3,

0310

87M

unim

ed14

795

5,33

696

32,

5148

045

20,0

234

000

104,

170,

4893

198

3368

165

766

1865

915

538

188

2,67

1166

Nat

iona

l Ind

epen

dent

Med

ical

Aid

So

ciet

y (N

IMA

S)10

145

14,3

06

285

8,86

1087

817

,50

2510

045

,97

1,38

9336

618

23

971

--

797

2,21

1167

Nat

iona

l Med

ical

Pla

n (N

MP)

1865

15,

2714

867

4,20

2478

28,

5683

419

97,6

21,

1535

901

322

748

9-

--

3261

32,

3711

70N

BC M

edic

al S

chem

e9

128

16,1

09

858

17,3

91

258

2,80

1350

010

2,25

1,05

5268

6-

--

--

3,86

1139

Om

nihe

alth

1545

414

,83

2232

321

,42

1949

520

,97

1350

099

,22

0,53

4220

4-

244

6-

-1

231

1,49

1560

Ope

npla

n M

edic

al S

chem

e4

254

4,29

428

14,

3222

095

25,6

814

021

97,9

10,

6015

627

555

008

3249

0-

165

05,

6812

15O

xyge

n5

086

1,96

713

82,

7559

726

27,4

752

300

138,

060,

8410

920

221

352

1-

253

7-

-1,

4515

87Pa

thfin

der

Med

ical

Sch

eme

229

6,80

737

21,8

83

153

162,

6564

447

,85

1,20

462

9-

--

-64

7,85

1546

Phar

os M

edic

al P

lan

346

49,

493

023

8,28

326

011

,14

950

798

,52

1,09

3070

2-

--

--

3,45

1454

Pro

Sano

Med

ical

Sch

eme

1760

27,

5125

418

10,8

566

368

32,1

137

000

114,

980,

7259

133

612

52

010

3998

4-

371

59,

4111

96Pr

otea

Med

ical

Aid

Soc

iety

325

231

,13

302

128

,92

726

7,20

311

599

,08

1,08

1805

92

930

984

--

-0,

6412

85Pr

otec

tor

Hea

lth14

763

9,51

1150

97,

4222

895

16,0

819

000

104,

520,

4644

566

352

712

257

--

221,

3915

95Pu

lz M

edic

al S

chem

e20

695

82,6

42

330

9,30

2607

817

8,58

611

211

7,86

1,64

3047

8-

--

--

6,86

1575

Res

olut

ion

Hea

lth M

edic

al

Sche

me

344

33,

262

080

1,97

398

06,

9713

410

100,

240,

8313

480

8-

--

-12

72,

1014

46Se

lfmed

Med

ical

Sch

eme

201

82,

841

203

1,70

1660

028

,25

1450

092

,25

0,88

101

708

2991

425

842

306

6-

206

03,

4014

86Si

zwe

Med

ical

Fun

d69

559

21,3

873

123

22,4

733

611

14,7

350

000

94,1

10,

7235

746

039

863

3345

3-

-94

4,81

1141

Spec

tram

ed44

161

15,6

420

650

7,31

1966

310

,11

6705

30,

001,

2234

859

4-

--

814

019

45,

9014

64Su

rem

ed H

ealth

984

7,31

117

08,

695

910

63,0

14

950

92,3

81,

7418

479

--

--

-6,

4811

47Te

lem

ed12

157

6,55

1011

35,

457

326

4,18

4550

090

,37

0,85

224

158

--

645

5-

326

4,21

1592

The

bem

ed29

811

,69

367

14,4

336

022

,84

169

5N

/A3,

543

655

--

--

-7,

63

Ref.

Nam

e of

Med

ical

Sch

eme

Acc

ount

s Re

ceiv

able

Con

trib

utio

n D

ebto

rsA

ccou

nts

Paya

ble

Out

stan

ding

Cla

ims

Prov

ision

Inve

stm

ents

Gro

ss C

laim

s

No.

Prio

r Yea

rC

over

ing

Cas

h an

dBo

nds

Equi

ties

Prop

ertie

sIn

sura

nce

Oth

erIn

curr

ed

Cla

ims

Net

tC

ash

and

Polic

yC

ash

and

Prov

ision

Cla

ims

Equi

vale

nts

Deb

entu

res

Cas

h

Util

ised

Equi

vale

nts

Day

sD

ays

Day

sC

over

age

R’00

0O

utst

andi

ngR’

000

Out

stan

ding

R’00

0O

utst

andi

ngR’

000

%M

onth

sR’

000

R’00

0R’

000

R’00

0R’

000

R’00

0M

onth

s


ANNEXURE N5

Deta

iled

fina

ncia

l re

sult

s: r

egis

tere

d sc

hem

esas

at

31 D

ecem

ber

2004

Detailed financial results: registered schemes

Ref.

Nam

e of

Med

ical

Sch

eme

Acc

ount

s Re

ceiv

able

Con

trib

utio

n D

ebto

rsA

ccou

nts

Paya

ble

Out

stan

ding

Cla

ims

Prov

ision

Inve

stm

ents

Gro

ss C

laim

s

No.

Prio

r Yea

rC

over

ing

Cas

h an

dBo

nds

Equi

ties

Prop

ertie

sIn

sura

nce

Oth

erIn

curr

ed

Cla

ims

Net

tC

ash

and

Polic

yC

ash

and

Prov

ision

Cla

ims

Equi

vale

nts

Deb

entu

res

Cas

h

Util

ised

Equi

vale

nts

Day

sD

ays

Day

sC

over

age

R’00

0O

utst

andi

ngR’

000

Out

stan

ding

R’00

0O

utst

andi

ngR’

000

%M

onth

sR’

000

R’00

0R’

000

R’00

0R’

000

R’00

0M

onth

s14

22To

pmed

Med

ical

Sch

eme

488

35,

441

251

1,40

1687

822

,90

1901

199

,56

0,98

156

602

2517

4-

--

-8,

0215

86X

-Pre

ss C

are

Med

ical

Sch

eme

292

88,

743

756

11,2

26

619

25,4

88

991

102,

971,

1532

912

--

--

-3,

78

SUB

-TO

TAL

–R

egist

ered

Ope

n Sc

hem

es1

333

468

13,2

21

088

952

10,7

91

607

204

20,6

21

539

540

100,

310,

7510

097

626

323

801

289

107

918

475

455

188

983

177

4,94

RE

GIS

TE

RE

D S

CH

EM

ES

– R

ES

TR

ICT

ED

1553

ABI

Med

ical

Sch

eme

880,

7065

0,52

508

6,27

170

475

,21

0,82

4576

5-

--

--

18,5

810

05A

ECI M

edic

al A

id S

ocie

ty7

668

15,4

77

646

15,4

23

540

7,52

1373

810

2,81

0,96

3842

319

137

6656

4-

--

2,81

1567

Afr

ox M

edic

al A

id S

ocie

ty16

343

38,0

012

376

28,7

84

471

12,3

46

298

106,

500,

6648

481

-9

401

--

-3,

9014

56A

llian

ce M

idm

ed M

edic

al S

chem

e2

817

24,2

62

206

19,0

025

53,

292

435

88,6

91,

4529

375

392

5-

--

-14

,11

1534

Altr

on M

edic

al A

id S

chem

e2

745

7,73

258

87,

291

620

5,43

934

599

,13

1,38

7933

98

316

-39

1-

-7,

4310

12A

nglo

Am

eric

an C

orpo

ratio

n M

edic

al S

chem

e (A

AC

MED

)10

152

12,6

28

382

10,4

21

663

2,47

1757

473

,24

1,10

114

847

241

449

590

410

208

946

471

-5,

6215

71A

nglo

vaal

Gro

up M

edic

al S

chem

e4

889

15,7

23

568

11,4

72

753

10,8

44

600

105,

360,

8259

255

1293

025

797

156

-18

309

7,67

1013

Ara

nda

Med

ical

Sch

eme

400

9,42

237

5,58

229

7,75

942

65,9

01,

059

681

--

--

-10

,77

1279

Bank

med

775

91,

953

396

0,85

184

698

51,9

244

777

94,3

80,

5052

431

532

731

410

855

021

957

-36

56,

6715

07Ba

rlow

orld

Med

ical

Sch

eme

226

34,

7422

20,

473

644

7,97

1230

310

3,25

0,88

109

346

--

--

-7,

8611

15Bi

z H

ealth

Med

ical

Sch

eme

403

140

,36

237

723

,80

362

738

,72

300

111,

020,

1120

748

274

913

--

-0,

8715

26BM

W E

mpl

oyee

s M

edic

al A

id

Soci

ety

447

2,72

710,

431

134

8,26

310

086

,42

0,74

4942

8-

--

681

4-

11,8

412

37BP

SA M

edic

al S

chem

e14

11,

2313

21,

152

441

18,4

82

256

98,8

90,

567

805

1324

215

033

419

8-

-1,

2715

90Bu

ildin

g &

Con

stru

ctio

n In

dust

ry

Med

ical

Aid

Fun

d29

03,

5311

81,

4430

75,

152

400

90,2

21,

3221

567

-96

9-

-0

11,8

815

93Bu

ilt E

nvir

onm

ent

Prof

essi

onal

A

ssoc

iatio

ns M

edic

al S

chem

e (B

EPS)

157

424

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ANNEXURE N5

Deta

iled

fina

ncia

l re

sult

s: r

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tere

d sc

hem

esas

at

31 D

ecem

ber

2004


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ANNEXURE N5

Deta

iled

fina

ncia

l re

sult

s: r

egis

tere

d sc

hem

esas

at

31 D

ecem

ber

2004


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s Re

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or

is g

ross

cla

ims

incu

rred

in

res

pec

t o

f ac

cou

nts

pay

able

ou

tsta

nd

ing

day

s.•

In r

esp

ect

of

pri

or

year

cla

ims

pro

visi

on

uti

lise

d =

pri

or

year

pay

men

ts /

pro

visi

on

at

the

beg

inn

ing

of

the

year

.•

In r

esp

ect

of

ou

tsta

nd

ing

clai

ms

pro

visi

on

cov

erin

g n

et c

laim

s =

pro

visi

on

at

end

of

year

/ n

et c

laim

s in

curr

ed.

•In

res

pec

t o

f G

ross

cla

ims

cash

cov

erag

e =

sho

rt t

erm

in

vest

men

ts /

gro

ss c

laim

sin

curr

ed.

•P

leas

e ta

ke n

ote

th

at i

n r

esp

ect

of

the

Pri

or

year

cla

ims

pro

visi

on

uti

lise

d:

- I

f it

is

abov

e 10

0%, t

he

sch

eme

un

der

pro

vid

ed i

n t

he

pri

or

year

.-

If

it i

s b

elow

100

%, t

he

sch

eme

over

pro

vid

ed i

n t

he

pri

or

year

.-

If

equ

al t

o z

ero

, no

in

form

atio

n w

as s

ub

mit

ted

.

•P

leas

e ta

ke n

ote

th

at e

ach

typ

e o

f as

set

clas

s in

lcu

des

bo

th l

on

g-te

rm a

nd

sh

ort

-ter

mas

wel

l as

th

ose

in

sid

e th

e R

epu

bli

c an

d o

uts

ide

the

Rep

ub

lic.


ANNEXURE N5

Deta

iled

fina

ncia

l re

sult

s: r

egis

tere

d sc

hem

esas

at

31 D

ecem

ber

2004


REG

ISTE

RED

SC

HEM

ES –

OPE

N15

89Ba

ymed

100

34

003

300

937

639

012

,96

4937

747

--

0,00

-N

/AN

/A-

0,00

--

0,00

--

0,00

--

0,00

1252

Best

med

Med

ical

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eme

2863

379

376

644

428

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6011

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3363

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818

118

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7213

592

1422

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716

97,

5311

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1512

Boni

tas

Med

ical

Aid

Fun

d21

843

156

455

43

883

967

573

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538

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ape

Med

ical

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n4

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Com

mer

cial

and

Indu

stria

l Med

ical

A

id S

ocie

ty (C

IMA

S)2

894

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281

480

894

816

810

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151

6812

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510

200

6,72

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2,03

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0,00

114

512

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215

52C

omm

unity

Med

ical

Aid

Sch

eme

(CO

MM

ED)

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532

424

222

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572

3785

617

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9732

579

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3694

810

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91C

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are

Med

ical

Sch

eme

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829

612

265

498

747

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--

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360,

100,

1311

25D

iscov

ery

Hea

lth M

edic

al S

chem

e63

410

01

510

623

1296

589

271

515

3572

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246

750

691

357

0,07

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754

381

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210

939

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--

0,00

1596

Eclip

se M

edic

al S

chem

e21

648

02

162

500

219

10,1

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142

33-

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N/A

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0068

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31

150

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114

719

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1388

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0,46

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1487

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8110

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1501

Free

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te M

edic

al A

id S

chem

e12

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82

017

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54G

enes

is M

edic

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chem

e7

328

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163

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Med

ical

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eme

601

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892

8173

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bal H

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330

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003

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d H

ope

Med

ical

Aid

Soc

iety

321

010

587

2675

121

12

948

11,0

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247

419

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57

300

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0,00

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37H

osm

ed M

edic

al A

id S

chem

e33

878

131

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e H

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ed M

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220,

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42M

edic

al E

xpen

ses

Dist

ribut

ion

Soci

ety

(MED

S)11

510

2402

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107

476

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101

1031

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over

200

035

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257

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645

648

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shie

ld M

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chem

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ian

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00,

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1,08

281

12,

003,

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48M

yhea

lth M

edic

al S

chem

e8

267

1709

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b11

66N

atio

nal I

ndep

ende

nt M

edic

al A

id

Soci

ety

(NIM

AS)

1506

735

669

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226

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iona

l Med

ical

Pla

n (N

MP)

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5333

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BC M

edic

al S

chem

e7

525

1824

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688

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030

10,6

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120

615

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00,

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penp

lan

Med

ical

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eme

1931

044

279

362

027

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010

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768

5432

00,

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2115

87Pa

thfin

der

Med

ical

Sch

eme

126

82

512

1229

840

83

206

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656

319

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9624

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000

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646

2120

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1546

Phar

os M

edic

al P

lan

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217

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133

279

624

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115

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5838

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733

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54Pr

o Sa

no M

edic

al S

chem

e43

168

116

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8103

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4307

131

115

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Med

ical

Aid

Soc

iety

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33

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Prot

ecto

r H

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3154

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843

566

492

556

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293

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Pulz

Med

ical

Sch

eme

595

313

474

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256

513

780

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475

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0,81

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151

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65-

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00-

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0015

75Re

solu

tion

Hea

lth M

edic

al S

chem

e26

475

6731

538

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008

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are

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ical

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giste

red

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n Sc

hem

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00

Ref.

Nam

e of

Med

ical S

chem

eM

embe

rsBe

nefic

iaries

Gro

ss

Gro

ss A

dmin

istra

tion

Gros

s Adm

inistr

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dit F

ees

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uner

atio

nPr

incip

al O

fficer

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sSt

affM

arke

ting

and

Adve

r- N

o.C

ontr

ibut

ions

Expe

nses

(RISK

+PM

SA)

Fees

Paid

& Ex

pens

esRe

mun

erat

ion

tisin

g Ex

pend

iture

AsAs

No

ofAV

G pe

rAs

As

AsAs

PA

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% of

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oftru

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age

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000

RG

AER'

000

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GAE

R'00

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GAE

R'00

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GAE


ANNEXURE O5

Deta

iled

fina

ncia

l re

sult

s: r

egis

tere

d sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20


Ref.

Nam

e of

Med

ical S

chem

eM

embe

rsBe

nefic

iaries

Gro

ss

Gro

ss A

dmin

istra

tion

Gros

s Adm

inistr

atio

nAu

dit F

ees

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tee

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uner

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nPr

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al O

fficer

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sSt

affM

arke

ting

and

Adve

r- N

o.C

ontr

ibut

ions

Expe

nses

(RISK

+PM

SA)

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Paid

& Ex

pens

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1507

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ANNEXURE O5

Deta

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64


ANNEXURE P5

Deta

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PAB

PM

= P

er A

vera

ge B

enef

icia

ry P

er M

on

th

•Th

ere

are

no

200

4 fi

gure

s fo

r th

e co

lor

cod

ed s

chem

es d

ue

to:

-Sc

hem

es l

iqu

idat

ing

du

rin

g th

e ye

ar (

Hig

hve

ld f

urn

ish

ed t

he

Off

ice

wit

hm

anag

emen

t ac

cou

nts

fo

r th

e 20

03 f

inan

cial

yea

r).

The

foll

owin

g sc

hem

es a

mal

gam

ated

in

200

4, a

nd

in

200

3•

All

care

wit

h N

BC

wit

h e

ffec

t fr

om

1 J

anu

ary

2004

.•

An

glo

gold

wit

h D

isco

very

Hea

lth

wit

h e

ffec

t fr

om

1 J

un

e 20

04.

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yhea

lth

wit

h O

xyge

n w

ith

eff

ect

fro

m 1

Ju

ly 2

004.

•B

illm

ed w

ith

Sam

anco

r w

ith

eff

ect

fro

m 1

Ju

ly 2

004.

•Jo

med

wit

h L

amaf

wit

h e

ffec

t fr

om

1 S

epte

mb

er 2

003.

•P

retm

ed w

ith

Glo

bal

Hea

lth

wit

h e

ffec

t fr

om

1 O

cto

ber

200

3.

•Th

ere

are

no

200

3 fi

gure

s fo

r th

e co

lor

cod

ed s

chem

es d

ue

to:

- Sc

hem

es r

egis

teri

ng

du

rin

g 20

04.


ANNEXURE P5

Deta

iled

fina

ncia

l re

sult

s: r

egis

tere

d sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20


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over

y H

ealth

(Pty

) Ltd

81

595

586

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91

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68

967

703

14,4

013

549

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911

633

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725

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sche

me

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935

360

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etro

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pora

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are

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117

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115

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111

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us M

edic

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id A

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ty) L

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perit

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ence

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214

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areCo

ntrib

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Share

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areCo

ntrib

ution

Share

Incur

red

Sche

mes

Sche

mes

Sche

mes

Sche

mes

Incom

e (GC

I)Inc

ome (

GCI)

Incom

e (GC

I)Inc

ome (

GCI)

2004

2004

2004

2003

2003

2003

2002

2002

2002

2001

2001

2001

2004

2004

2004

2003

2003

2003

2002

2002

2002

2001

2001

2001

2004

2004

%%

%%

R’00

0R

%R’

000

R%

R’00

0R

%R’

000

R%

R’00

0R


ANNEXURE Q5

Adm

inis

trat

ors’

mar

ket

shar

es a

nd r

elev

ant

cash

flo

ws

for

the

year

end

ed 3

1 De

cem

ber

2004

Administrators’ market shares and relevant cash flows

Adm

inist

rato

r na

me

Claim

sN

ett C

laim

sPA

BPM

Claim

sN

ett C

laim

sPA

BPM

Claim

sN

ett C

laim

sPA

BPM

Claim

sG

ross

PABP

MAs

% o

fG

ross

PABP

MAs

% o

fG

ross

PABP

MAs

% o

fG

ross

PABP

MAs

% o

fRa

tioIn

curr

edRa

tioIn

curr

edRa

tioIn

curr

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tioAd

mini

strat

ion

GCI

Adm

inistr

atio

nG

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mini

strat

ion

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inistr

atio

nG

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pend

iture

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nditu

reEx

pend

iture

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nditu

re20

0420

0320

0320

0320

0220

0220

0220

0120

0120

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ANNEXURE Q5

Adm

inis

trat

ors’

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ket

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es a

nd r

elev

ant

cash

flo

ws

for

the

year

end

ed 3

1 De

cem

ber

2004


Note

s:•

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e M

ed (

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d c

han

ged

its

nam

e to

Afr

ican

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e H

ealt

h (

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agem

ent

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d c

han

ged

its

nam

e to

MX

Net

wo

rk S

yste

ms

(Pty

) Lt

d•

Ave

rage

ben

efic

iari

es f

or

the

year

wer

e u

sed

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mp

arat

ive

figu

res

wer

e re

stat

ed•

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PM

= P

er A

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enef

icia

ry P

er M

on

th•

B a

nd

M M

edic

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chem

e A

dm

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ors

(P

ty)

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ch

ange

d i

ts n

ame

to B

enm

edM

edic

al S

chem

e A

dm

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trat

ors

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ty)

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mal

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e in

clu

ded

in

th

e ad

min

-is

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as a

t ye

ar-e

nd

.


ANNEXURE Q5

Adm

inis

trat

ors’

mar

ket

shar

es a

nd r

elev

ant

cash

flo

ws

for

the

year

end

ed 3

1 De

cem

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2004


Ref.

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Decre

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e(2

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191)

6,78

47,89

--

(119

61)

(119

61)

10,59

46,54

(190

)-

(371

1)(3

902)

5,49

59,80

--

(187

0)(1

870)

3,42

81,70

1536

Lifem

ed M

edica

l Sch

eme

(71)

-53

(18)

0,13

1,00

(34)

-(1

09)

(143

)1,1

81,2

4(6

)-

-(6

)0,0

65,0

2-

-(6

0)(6

0)0,7

31,0

9-

--

-0,0

01,8

011

42Me

dical

Expe

nses

Di

stribu

tion

Socie

ty (M

EDS)

(484

)34

344

(106

)0,3

42,9

7(1

34)

-(7

32)

(865

)2,5

14,0

0(1

751)

-41

1(1

340)

3,29

7,12

--

(316

1)(3

161)

15,69

43,39

--

(526

4)(5

264)

27,92

70,66

1549

Medic

over

200

0(1

838)

--

(183

8)2,5

60,0

0-

-16

0616

06-3

,210,0

0-

-59

6259

62-1

5,55

0,00

(10)

-70

569

5-1

,760,0

0(3

4)-

(108

18)

(108

52)

11,08

0,00

1149

Medih

elp(3

81)

263

1522

1404

-0,56

13,76

(218

7)13

3(2

467)

(452

1)1,9

18,6

9(3

948)

8710

46(2

815)

1,39

15,60

(254

4)65

(384

)(2

863)

1,46

60,00

(130

8)42

(345

0)(4

715)

3,98

60,00

1506

Medim

ed M

edica

l Sch

eme

--

--

0,00

0,00

--

--

0,00

0,00

--

--

0,00

0,00

--

--

0,00

0,00

--

--

0,00

0,00

1140

Meds

hield

Medic

al Sc

heme

-9

(108

44)

(108

35)

3,39

85,88

(603

7)60

5(3

3706

)(3

9138

)9,9

482

,81-

-(1

2000

)(1

2000

)3,4

646

,34-

-(1

7590

)(1

7590

)6,5

12,0

9-

-(1

641)

(164

1)0,9

2-2

1,81

1021

Merid

ian H

ealth

(206

)-

71(1

35)

2,03

5,92

--

(210

)(2

10)

1,39

0,00

--

(549

)(5

49)

2,89

0,00

-35

3(1

90)

163

-0,88

0,00

(132

5)-

-(1

325)

30,38

0,00

1087

Munim

ed-

-(2

744)

(274

4)1,8

70,0

0(4

01)

-(7

908)

(830

9)6,3

20,0

0(1

979)

-(7

00)

(267

9)2,5

50,0

0(1

60)

--

(160

)0,1

819

,05(1

741)

--

(174

1)4,1

420

,0111

48My

healt

h Me

dical

Sche

me(2

40)

-(6

24)

(864

)6,9

20,0

0(1

500)

134

-(1

366)

5,04

0,72

(329

9)29

113

08(1

700)

6,08

63,82

(352

4)19

4311

57(4

24)

1,64

30,89

(107

76)

1052

1217

(850

7)41

,6170

,1611

66Na

tiona

l Inde

pend

ent

Medic

al Ai

d So

ciety

(NIM

AS)

(140

)-

-(1

40)

0,65

6,48

(115

)-

-(1

15)

0,72

-0,49

(136

)-

90(4

6)0,3

30,6

7(1

40)

-25

(115

)0,8

73,4

7(3

71)

-(6

5)(4

36)

4,18

3,68

1167

Natio

nal M

edica

l Plan

(NMP

)-

-27

727

7-0

,163,5

4-

-16

3916

39-0

,960,0

0-

-(1

220)

(122

0)0,7

90,0

0-

-(1

217)

(121

7)0,8

83,5

4-

-(1

108)

(110

8)0,8

50,0

011

70NB

C Me

dical

Sche

me-

-(2

28)

(228

)0,8

025

,13-

-(6

31)

(631

)2,8

01,9

5(1

81)

-23

453

-0,18

1,96

--

(356

)(3

56)

1,75

16,38

--

(92)

(92)

0,40

0,00

1139

Omn

ihealt

h(10

5809

)12

010

2320

(336

9)5,7

734

,65(7

061)

-(7

9649

)(8

6710

)41

,6489

,23(25

482)

12(6

656)

(321

26)

14,20

38,60

-5

(122

07)

(122

02)

4,44

21,43

(465

)2

3147

2684

-1,33

25,00

1560

Ope

nplan

Med

ical S

chem

e(4

99)

636

416

553

-1,05

6,97

(512

2)38

956

5792

4-1

,6020

,08(2

60)

683

2794

3217

-4,49

64,38

(114

0)-

(100

91)

(112

32)

6,14

61,22

(202

38)

415

(638

6)(2

6209

)13

,3834

,1512

15O

xyge

n(2

425)

440

1067

(918

)0,5

560

,65(1

629)

1289

711

371

-0,34

69,93

(781

8)-

1741

996

01-7

,6671

,57(5

12)

-(4

563)

(507

5)3,5

971

,38(2

78)

-(6

002)

(628

0)4,9

582

,2615

87Pa

thfin

der M

edica

l Sch

eme

--

(369

)(3

69)

8,63

34,13

--

(200

)(2

00)

5,88

92,92

--

--

0,00

0,00

--

--

0,00

0,00

N/A

N/A

N/A

N/A

N/A

N/A

1546

Phar

os M

edica

l Plan

--

--

0,00

4,83

--

--

0,00

2,22

--

(50)

(50)

0,34

4,52

--

255

255

-2,31

16,39

--

(60)

(60)

1,06

13,66

1454

Pro

Sano

Med

ical S

chem

e(1

2)6

2473

2467

-2,58

80,03

(75)

8(1

623)

(169

0)1,8

066

,26-

1618

9319

09-2

,5489

,20-

2623

3323

59-3

,3587

,07-

5881

8482

42-1

3,98

96,61

1196

Prot

ea M

edica

l Aid

Socie

ty(3

13)

-51

820

5-4

,213,1

9(3

20)

-(2

59)

(579

)10

,414,9

9(1

29)

-(2

10)

(339

)5,7

213

,94(2

89)

-37

586

-3,63

9,56

--

(550

)(5

50)

12,48

12,79

1285

Prot

ecto

r Hea

lth22

-(2

965)

(294

3)4,2

22,7

5(5

398)

268

3346

(178

4)2,2

94,0

1(8

57)

996

(217

3)(2

034)

3,32

6,61

(692

2)29

227

66(3

864)

7,81

29,69

(733

)-

(118

2)(1

914)

19,44

22,37

1595

Pulz

Medic

al Sc

heme

--

(332

)(3

32)

1,51

0,00

--

(39)

(39)

2,60

0,00

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

1575

Reso

lution

Hea

lth M

edica

l Sc

heme

(585

)-

(301

)(8

86)

0,71

8,90

(133

6)-

51(1

285)

1,62

12,74

--

440

440

-1,01

21,43

--

(565

)(5

65)

3,18

12,82

(50)

-56

6-0

,360,0

014

46Se

lfmed

Med

ical S

chem

e(1

56)

6256

(38)

0,11

53,22

-83

(116

1)(1

078)

2,74

40,13

(903

1)-

7202

(183

0)3,7

754

,32-

-(5

875)

(587

5)11

,5970

,50-

-(5

72)

(572

)1,0

810

0,00

1486

Sizwe

Med

ical F

und

(43)

-(1

4850

)(1

4893

)8,0

50,0

0(3

758)

-(1

453)

(521

0)3,1

14,4

9(10

336)

-85

83(1

753)

1,09

4,49

(660

)-

459

(200

)0,1

230

,95(1

498)

-(3

000)

(449

8)3,2

465

,3911

41Sp

ectra

med

(357

1)40

0064

4168

70-4

,360,0

0-

-34

7034

70-3

,6012

,30-

-(1

6920

)(1

6920

)18

,760,0

0(1

393)

-(1

116)

(250

9)8,1

923

,00(7

15)

-(5

83)

(129

7)3,7

735

,0014

64Su

reme

d He

alth

(669

)-

(665

)(1

334)

11,51

33,29

(283

5)-

(230

0)(5

135)

37,44

24,26

--

(821

)(8

21)

16,72

39,24

95-

(554

)(4

60)

13,20

0,00

(463

)-

(432

)(8

95)

35,08

62,40


ANNEXURE R5

Impa

ired

rec

eiva

bles

: 20

04 r

egis

tere

d sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20

04Impaired receivables: 2004 registered schemes

1147

Telem

ed-

-25

9825

98-6

,0561

,14(1

65)

-(2

713)

(287

8)6,9

038

,43(1

1)-

(159

9)(1

610)

3,17

5,92

(592

)-

(299

)(8

91)

2,03

0,00

(595

)-

(743

)(1

339)

3,05

22,53

1592

Theb

emed

--

(87)

(87)

4,41

23,81

--

--

0,00

0,00

--

--

0,00

0,00

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

1422

Topm

ed M

edica

l Sch

eme

(1)

1533

034

4-0

,853,5

3(4

415)

-29

53(1

462)

3,33

0,00

(452

3)-

976

(354

7)5,9

574

,72(8

)-

(178

8)(1

796)

2,73

29,98

(13)

-(1

346)

(135

8)4,0

210

0,00

1586

X-Pr

ess C

are M

edica

l Sch

eme

(430

)-

(905

)(1

334)

5,18

51,60

(880

)-

(367

)(1

246)

7,52

22,13

--

--

0,00

24,07

--

(360

)(3

60)

8,55

65,10

N/A

N/A

N/A

N/A

N/A

N/A

SUB

-TO

TAL

– Re

giste

red

Ope

n Sc

hem

es(12

5223

)57

9632

561

(868

65)

1,53

13,32

(446

35)

3389

(1459

12)(

1871

58)

3,58

26,44

(866

53)

2148

(341

48)

(1186

54)

2,55

16,24

(1139

72)

1079

4(6

8176

)(17

1354

)3,9

829

,56(56

864)

1007

8(6

2946

)(10

9732

)3,7

627

,83

RE

GIS

TE

RE

D S

CH

EM

ES

- R

EST

RIC

TE

D15

53AB

I Med

ical

Sche

me(4

4)8

8751

-1,53

0,40

(35)

193

58-1

,85-9

,81(5

8)1

(181

)(2

37)

7,64

22,06

(7)

219

13-0

,4911

,16-

2(4

6)(4

4)2,2

54,8

210

05AE

CI M

edica

l Aid

Socie

ty(6

9)-

(90)

(159

)0,9

62,3

8(1

77)

-15

(162

)1,0

030

,76(5

7)-

-(5

7)0,3

994

,68-

-(5

9)(5

9)0,5

10,0

0-

2(2

57)

(255

)2,5

643

,8815

67Af

rox

Medic

al Ai

d So

ciety

(164

)19

(376

)(5

21)

4,60

5,20

(163

)16

(147

)(2

93)

3,29

2,97

(2)

3(1

05)

(104

)1,4

60,0

0(5

1)-

(213

)(2

64)

4,04

0,00

--

(88)

(88)

1,84

0,00

1456

Allia

nce M

idmed

Med

ical

Sche

me(0

)-

5959

-1,71

0,00

(401

)-

204

(197

)5,6

33,8

6(1

5)-

(276

)(2

91)

8,43

1,97

(6)

-59

53-1

,820,0

0-

0(7

5)(7

5)2,6

87,4

015

34Al

tron

Medic

al Ai

d Sc

heme

(196

)-

(478

)(6

74)

4,70

1,78

--

(197

)(1

97)-1

47,07

1,02

--

(488

)(4

88)

14,02

0,00

--

(138

)(1

38)

1,59

13,66

(113

)-

(303

)(4

16)

4,43

0,00

1012

Anglo

Ame

rican

Cor

pora

tion

Medic

al Sc

heme

(AAC

MED)

(263

)21

221

115

9-0

,730,0

0(1

224)

105

1171

53-0

,250,0

0-

14(2

93)

(279

)1,3

00,0

0-

-64

464

4-2

,480,0

0(0

)-

(589

)(5

89)

1,90

39,59

1503

Anglo

gold

Medic

al Sc

heme

(G

oldme

d)-

-(1

8)(1

8)2,2

50,0

0-

-42

42-3

,7462

,96-

-78

78-8

,841,8

9-

-(3

71)

(371

)-40

,5949

,10-

-(3

4)(3

4)0,0

417

,5315

71An

glova

al Gr

oup

Medic

al Sc

heme

(19)

-18

916

9-1

,55-3

,32(1

3)-

(238

)(2

52)

2,32

-4,67

(1)

-(2

36)

(237

)2,2

7-3

,20(4

93)

4236

8(8

4)1,1

60,0

0(5

45)

459

200

114

-1,69

22,48

1013

Aran

da M

edica

l Sch

eme

--

--

0,00

0,00

--

--

0,00

0,00

--

--

0,00

0,00

--

--

0,00

0,00

--

--

0,00

0,00

1279

Bank

med

(157

)14

6(3

75)

(386

)0,2

534

,90(1

777)

103

1176

(497

)0,3

830

,01(1

80)

313

3011

53-1

,020,0

0(2

35)

-(1

150)

(138

5)1,3

936

,22(1

589)

-(5

198)

(678

7)7,9

20,0

015

07Ba

rlowo

rld M

edica

l Sch

eme

(54)

-13

985

-0,65

13,55

(76)

416

391

-0,66

13,43

(171

)-

1535

1363

-13,35

-0,13

(47)

-(1

343)

(139

1)10

,806,7

5(1

2)0

(119

)(1

31)

1,33

-6,67

1089

Billm

ed M

edica

l Sch

eme

-1

(145

)(1

44)

7,66

0,00

(104

)7

383

286

-8,79

2,37

0-

(143

)(1

43)

6,08

51,68

(18)

-(1

87)

(205

)8,0

166

,06(5

70)

-37

2(1

98)

7,08

76,15

1115

Biz H

ealth

Med

ical S

chem

e(2

57)

--

(257

)6,3

10,0

0(1

15)

-10

0(1

5)0,4

80,0

9(1

)-

5049

-1,66

5,51

--

(55)

(55)

1,59

6,00

--

387

387

-14,05

15,00

1526

BMW

Emp

loyee

s Med

ical

Aid

Socie

ty(1

1)0

(4)

(15)

0,30

3,22

(66)

-10

438

-0,78

2,30

(143

6)-

(19)

(145

5)25

,030,0

0(4

)-

196

192

-4,53

0,00

-8

(163

)(1

55)

3,92

80,61

1237

BPSA

Med

ical S

chem

e(1

)-

(4)

(5)

0,14

37,10

(189

)-

187

(2)

0,07

1,96

(11)

-30

629

5-10

,1411

,48-

-(5

25)

(525

)68

,8083

,38-

-(2

5)(2

5)3,1

20,0

015

90Bu

ilding

& C

onstr

uctio

n Ind

ustry

Med

ical A

id Fu

nd-

--

-0,0

012

,61-

--

-0,0

00,0

0-

--

-0,0

00,0

0-

--

-0,0

00,0

0N/

AN/

AN/

AN/

AN/

AN/

A15

93Bu

ilt En

viron

ment

Profe

ssion

al

Asso

ciatio

ns M

edica

l Sch

eme

(BEP

S)-

-(2

1)(2

1)0,6

20,0

0(2

)-

(8)

(10)

0,37

0,40

--

--

0,00

0,00

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

1158

Cawm

ed M

edica

l Sch

eme

--

--

0,00

0,00

--

--

0,00

0,00

--

--

0,00

0,00

--

(25)

(25)

2,28

0,00

--

--

0,00

0,00

1043

Char

tere

d Acc

ount

ants

(SA)

Medic

al Ai

d Fu

nd (C

AMAF

)-

-45

245

2-1

,055,5

2-

-(2

)(2

)0,0

125

,29(1

8)48

(300

)(2

69)

0,76

17,08

(109

4)-

-(1

094)

3,41

30,95

(146

)16

300

170

-0,77

15,06

1521

Click

s Gro

up M

edica

l Sch

eme

(176

)1

(169

)(3

44)

9,82

86,39

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0,04

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1484

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(136

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63)

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5,42

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82(1

39)

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00)

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19)

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71Fis

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med)

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12,76

34,64

--

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1086

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0,67

15,06

(285

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163

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35)

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92)

3,88

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(127

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27)

2,68

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1270

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ANNEXURE R5

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--

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2,57

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0,61

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1559

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(KDM

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9150

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9,48

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e(3

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e(3

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Med

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66Mo

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s Med

ical A

id So

ciety

(49)

-67

18-0

,190,0

0(1

02)

1012

735

-0,41

0,00

(178

)1

124

(53)

0,69

-42,5

9(1

03)

0(8

0)(1

83)

3,06

109,1

7-

0(1

59)

(159

)2,8

327

,4814

24SA

BC M

edica

l Aid

Sche

me(3

4)9

(143

)(1

68)

2,96

49,75

(70)

248

(20)

0,39

82,62

(123

)0

22(1

02)

2,02

-413

,06(1

78)

113

8(3

8)0,7

60,8

5-

046

46-0

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1,99

1557

Sama

ncor

Hea

lth P

lan(1

25)

5(5

3)(1

73)

1,90

13,46

(109

)14

79(1

6)0,2

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8(1

370)

-17

9442

3-8

,567,5

5(1

7)-

(15)

(32)

0,54

48,12

(309

)-

(448

)(7

56)

12,55

27,52

1038

SAMW

UMed

(305

)-

(102

)(4

07)

2,37

15,00

(30)

-(5

53)

(583

)4,7

914

,00-

-54

54-0

,590,0

0(1

057)

-40

0(6

57)

6,93

0,00

--

(500

)(5

00)

6,43

0,00

1527

Sapp

i Med

ical A

id Sc

heme

(92)

783

(2)

0,04

0,71

(143

)15

340

212

-3,87

0,50

--

3737

-0,77

0,57

--

(261

)(2

61)

4,13

0,00

(468

)-

-(4

68)

8,51

0,16

1234

Saso

lmed

(974

)26

1200

252

-0,60

0,00

(156

6)4

2524

961

-2,37

9,76

(866

)1

(113

7)(2

002)

5,21

1,53

-0

231

231

-0,89

0,00

(600

)-

961

361

-2,63

0,00

1531

Sedm

ed-

--

-0,0

00,0

0-

--

-0,0

00,0

0-

--

-0,0

00,0

0-

--

-0,0

00,0

0-

--

-0,0

00,0

012

43Sie

mens

Med

ical S

chem

e(6

2)1

58(3

)0,0

61,4

3(1

8)0

(94)

(112

)1,8

00,0

6-

-41

41-0

,59-0

,10-

--

-0,0

035

,00-

--

-0,0

00,0

015

80So

uth A

frica

n Po

lice S

ervic

e Me

dical

Sche

me (P

OLM

ED)

-33

8(1

859)

(152

1)0,6

891

,34(7

565)

0(2

884)

(104

49)

4,50

83,09

-4

(953

7)(9

533)

3,95

76,68

-28

(497

)(4

70)

0,22

85,67

--

(371

3)(3

713)

2,34

81,58

1254

Stock

smed

(105

)8

111

14-1

,043,6

6(2

09)

1225

356

-4,53

3,75

(46)

-58

12-0

,7519

,16-

-84

84-5

,270,3

1-

-(4

06)

(406

)19

,2078

,9215

44Tig

er B

rands

Med

ical S

chem

e-

--

-0,0

01,7

1-

--

-0,0

03,7

1-

--

-0,0

02,5

8-

--

-0,0

016

,90-

--

-0,0

022

,3015

82Tr

ansm

ed M

edica

l Fun

d-

55(3

70)

(315

)0,2

43,7

6-

-(9

89)

(989

)0,7

539

,06(5

231)

-52

343

0,00

38,89

--

(673

4)(6

734)

5,91

57,54

(1281

8)-

5594

(722

4)6,3

45,5

315

79Ts

ogo

Sun

Grou

p Me

dical

Sche

me(3

3)-

4614

-0,26

13,73

--

(94)

(94)

1,59

8,54

--

(69)

(69)

1,13

0,00

(40)

--

(40)

0,69

0,00

(76)

-12

953

-1,76

0,00

Ref.

Nam

e of

Med

ical S

chem

e20

0420

0320

0220

0120

00No

.Im

paire

dIm

paire

d(In

crease

)/To

tal%

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ibutio

nsIm

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paire

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crease

)/To

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ibutio

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paire

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paire

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crease

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tal%

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ibutio

nsIm

paire

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paire

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crease

)/To

tal%

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ibutio

nsIm

paire

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paire

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crease

)/To

tal%

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ibutio

nsRe

ceiva

blesR

eceiv

ables

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aseIm

paire

dof

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andin

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blesR

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ables

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aseIm

paire

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ables

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blesR

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ables

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vered

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e tha

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vered

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e tha

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vered

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hfor

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e tha

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vered

inRe

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e tha

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vered

inRe

ceiva

bles

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hfor

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e tha

nOf

fPro

vision

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n-60

Days

asOf

fPro

vision

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n-60

Days

asOf

fPro

vision

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n-60

Days

asOf

fPro

vision

Expe

n-60

Days

asOf

fPro

vision

Expe

n-60

Days

asfor

Impa

ired

diture

of Ar

rear

for Im

paire

ddit

ureof

Arrea

rfor

Impa

ired

diture

of Ar

rear

for Im

paire

ddit

ureof

Arrea

rfor

Impa

ired

diture

of Ar

rear

Rece

ivable

sCo

ntribu

tions

Rece

ivable

sCo

ntribu

tions

Rece

ivable

sCo

ntribu

tions

Rece

ivable

sCo

ntribu

tions

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ivable

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ntribu

tions

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000

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0R’

000

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0R’

000

%%

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0R’

000

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0R’

000

%%


ANNEXURE R5

Impa

ired

rec

eiva

bles

: 20

04 r

egis

tere

d sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20


1434

Umed

(260

)-

-(2

60)

1,54

12,98

(122

)-

(82)

(204

)1,3

520

,06(1

77)

--

(177

)1,2

513

,93(3

98)

812

6(2

65)

2,10

51,62

(125

)-

(17)

(142

)1,5

08,9

715

97Um

vuzo

Hea

lth M

edica

l Sc

heme

--

(12)

(12)

0,73

9,56

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

1520

Unive

rsity

of N

atal M

edica

l Sc

heme

(0)

-(2

)(2

)0,0

40,0

0(1

8)-

(26)

(44)

0,88

0,00

(52)

-(1

50)

(202

)4,8

40,0

0(0

)-

-(0

)0,0

00,0

0-

--

-0,0

00,0

012

82Un

iversi

ty of

the W

itwate

rs-ran

d Staf

f Med

ical A

id Sc

heme

(147

)-

814

668-

13,12

55,44

(283

)15

273

4-0

,08-1

06,65

(13)

1(7

)(1

9)0,4

176

,33(2

67)

048

321

5-4

,9838

,22-

0(2

07)

(206

)6,3

515

,0915

65Ve

nda P

olice

and P

rison

s Me

dical

Sche

me (P

olpris

med)

--

--

0,00

N/A

--

--

0,00

0,00

--

--

0,00

0,00

--

--

0,00

0,00

--

--

0,00

0,00

1291

Witb

ank C

oalfie

lds M

edica

l Ai

d Sc

heme

(87)

0-

(87)

1,20

0,00

(84)

4-

(80)

1,14

0,00

(74)

19-

(55)

0,67

0,00

(58)

4(3

50)

(404

)7,1

90,0

0(1

11)

3-

(108

)2,4

60,0

012

93W

ooltr

u He

althc

are F

und

(37)

018

(18)

0,13

0,00

(14)

08

(7)

0,05

0,00

(77)

183

6-0

,054,3

6(3

63)

1460

525

7-2

,6510

0,00

(111

)-

(753

)(8

64)

9,62

0,00

1253

Xstra

ta Me

dical

Aid

Sche

me(4

0)-

167

127

-1,82

1,12

(6)

-99

93-1

,473,1

7(9

9)-

(90)

(189

)3,1

11,3

0(7

7)-

(85)

(162

)3,5

00,8

8-

-(1

46)

(146

)3,6

34,0

1

SUB-

TOTA

L –

Regis

tere

d Re

strict

ed Sc

heme

s(1

2159

9)14

43(4

402)

(1245

59)

8,58

14,60

(1251

36)

634

(795

0)(1

3245

2)9,6

713

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7879

)22

025

54(1

5106

)1,3

418

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830)

1288

(163

60)

(229

02)

2,35

21,02

(207

18)

870

(161

14)

(359

62)

3,91

17,63

TOTA

L RE

GIST

ERED

SCH

EMES

(2468

22)

7239

2815

9(21

1424

)2,9

613

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9771

)40

24(15

3862

)(31

9610

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424

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4532

)23

68(3

1595

)(13

3759

)2,3

216

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1802

)12

081

(845

35)(

1942

56)

3,68

28,16

(7758

2)10

948

(7906

0)(14

5694

)3,8

025

,89

Ref.

Nam

e of

Med

ical S

chem

e20

0420

0320

0220

0120

00No

.Im

paire

dIm

paire

d(In

crease

)/To

tal%

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ibutio

nsIm

paire

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paire

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crease

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ibutio

nsIm

paire

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paire

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crease

)/To

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ibutio

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paire

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paire

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crease

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ibutio

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paire

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paire

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crease

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ibutio

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blesR

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ables

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aseIm

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ables

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aseIm

paire

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vered

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e tha

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Days

asOf

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vision

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n-60

Days

asOf

fPro

vision

Expe

n-60

Days

asOf

fPro

vision

Expe

n-60

Days

asOf

fPro

vision

Expe

n-60

Days

asfor

Impa

ired

diture

of Ar

rear

for Im

paire

ddit

ureof

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rfor

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ired

diture

of Ar

rear

for Im

paire

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rfor

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ired

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of Ar

rear

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tions

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tions

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tions

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000

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000

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Note

s:a

Dra

ft a

nn

ual

fin

anci

al s

tate

men

ts w

ere

sub

mit

ted

fo

r 20

04.

•Th

e co

mp

arit

ive

figu

res

wer

e o

nly

in

clu

ded

fo

r th

ose

sch

emes

th

at w

ere

in o

per

atio

nd

uri

ng

2004

.

The

foll

owin

g sc

hem

es a

mal

gam

ated

in

th

e 20

04 y

ear:

- A

llca

re w

ith

NB

C w

ith

eff

ect

fro

m 1

Jan

uar

y 20

04.

- A

ngl

ogo

ld w

ith

Dis

cove

ry H

ealt

h w

ith

eff

ect

fro

m 1

Ju

ne

2004

.-

Myh

ealt

h w

ith

Oxy

gen

wit

h e

ffec

t fr

om

1 J

uly

200

4.-

Bil

lmed

wit

h S

aman

cor

wit

h e

ffec

t fr

om

1 J

uly

200

4.

•Th

ere

are

no

co

mp

arit

ive

figu

res

for

the

colo

r co

ded

sch

emes

du

e to

:-

Sch

emes

wer

e re

gist

ered

du

rin

g th

e 20

04 y

ear.


ANNEXURE R5

Impa

ired

rec

eiva

bles

: 20

04 r

egis

tere

d sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20


3456

Aut

owor

kers

Med

ical

Aid

Fun

d (A

utom

ed)

2722

268

303

1,51

155

738

202

1345

28,

6417

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00-

-83

,72

2535

711

906

1024

321

355

157

414

157

310

101,

01a

3514

Barg

aini

ng C

ounc

il fo

r th

e Bu

ildin

g In

dust

ry (K

imbe

rly)

146

209

0,43

103

538

055

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,52

203

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00-

-24

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779

225

225

353

211

42

114

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g In

dust

ry M

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al A

id F

und

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tern

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--

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und

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tern

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23

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stry

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ape

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5,21

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167

7)(6

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133

27C

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ing

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stry

Med

ical

Ben

efit

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me

(Fre

e St

ate

& N

othe

rn C

ape)

543

543

-26

341

4818

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7-

0,00

--

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937

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(11)

5352

850

519

1,78

3339

Clo

thin

g In

dust

ry M

edic

al B

enef

it So

ciet

y (N

orth

ern

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as)

633

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330

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936

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118

,82

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0,00

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267

6(6

4)(6

4)14

42

165

216

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thin

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ry S

ick

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fit F

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al)

1668

916

689

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312

563

969

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00-

-35

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81

529

152

22

587

1401

714

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123,

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19K

nitt

ing

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stry

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ical

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efit

Soci

ety

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ther

n A

reas

)42

853

30,

2525

139

5220

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8-

0,00

--

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(1)

204

218

32

100

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otor

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stry

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ical

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IMED

)24

214

5382

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2245

914

171

117

245

3,76

2710

176

2,22

16-

85,7

565

368

3794

737

447

5330

722

684

022

684

049

,41

3479

Nat

al F

urni

ture

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kers

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k Be

nefit

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ciet

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466

146

6-

208

611

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-47

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109

340

4028

42

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211

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1,59

3314

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al H

aird

ress

ers

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efit

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722

788

0,09

488

5215

3,06

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--

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46(7

)(2

2)(2

2)(4

3)51

051

010

4,56

TOTA

L B

AR

GA

ININ

G C

OU

NC

IL S

CH

EMES

117

058

253

103

1,16

679

478

224

5070

37,

4617

2005

62,

957

-80

,34

113

566

4280

839

335

7423

343

937

943

554

464

,10

Ref.

Nam

e of

Med

ical

Sch

eme

No.o

fGr

oss

Gros

s Adm

inistr

ation

Ma

nage

d Ca

re:

Nett

Nett

Claim

sGr

oss

Nett

Surp

lus/

Nett

Nett

Asse

tsNe

tt As

sets

Solve

ncy

No.

Memb

ers

Bene

ficiar

iesDe

pend

ants

Cont

ribut

ions

Expe

nses

(RISK

+PM

SA)

Mana

geme

nt Se

rvice

sRe

insur

ance

Inc

urre

d:Un

derw

riting

Unde

rwrit

ing

(Defi

cit)

Surp

lus/

(Mem

bers’

Per

Ratio

per M

embe

rRe

sults

Nett

Resu

ltsRe

sults

from

(Defi

cit)

Fund

sRe

gulat

ionCo

ntribu

tions

Ope

ratio

nspe

r BS)

29PA

BPM

As %

of

PABP

MAs

% o

fPA

BPM

31/12

/0431

/12/04

R’00

0R

R’00

0GC

IR

R’00

0GC

IR

R’00

0%

R’00

0R’

000

R’00

0R’

000

R’00

0R’

000

%

Note

s:a

An

en

cum

ber

ed a

sset

was

exc

lud

ed i

n t

he

2004

cal

cula

tio

n o

f th

e so

lven

cy r

atio

.

•P

MSA

= P

erso

nal

Med

ical

Sav

ings

Acc

ou

nt

•G

CI

= G

ross

Co

ntr

ibu

tio

n I

nco

me

•PA

BP

M =

Per

Ave

rage

Ben

efic

iary

Per

Mo

nth

•B

S =

Bal

ance

Sh

eet

•N

o b

roke

r fe

es w

ere

pai

d b

y th

e sc

hem

es


ANNEXURE S5

Deta

iled

fina

ncia

l re

sult

s: b

arga

inin

g co

unci

l sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20

04Detailed financial results: bargaining council schemes

Ref.

Nam

e of

Med

ical S

chem

eBe

nefic

iaries

Gros

s Con

tribu

tion

Incom

e Ne

tt Cl

aims I

ncur

red

Gros

s Adm

inistr

ation

Exp

ense

s Re

serv

e Pos

ition

Solve

ncy

No.

(GCI

)(in

cl PM

SA C

laims

)(in

cl PM

SA &

Man

aged

Care

)(p

er R

egula

tion

29)

Ratio

Aver

ageAv

erage

%20

0420

03%

PABP

MPA

BPM

%20

0420

03%

PABP

MPA

BPM

%20

0420

03%

PABP

MPA

BPM

%20

0420

03%

PBPB

%20

0420

0320

0420

03Gr

owth

R’000

R’000

Grow

th20

0420

03Gr

owth

R’000

R’000

Grow

th20

0420

03Gr

owth

R’000

R’000

Grow

th20

0420

03Gr

owth

R’000

R’000

Grow

th20

0420

03Gr

owth

%%

RR

RR

RR

RR

3456

Auto

work

ers M

edica

l Aid

Fund

(Aut

omed

)64

324

6251

33

1557

3811

8319

3220

215

828

1303

8110

9807

1916

914

615

1345

213

303

117

18-2

1573

1013

7914

1423

0321

467

101,0

111

6,56

3514

Barg

aining

Cou

ncil

for t

he

Build

ing In

dustr

y (K

imbe

rly)

227

188

2110

3574

140

380

329

1525

623

49

9410

4-1

055

467

5-1

820

330

0-3

221

1417

6620

1011

313

584

-26

204,1

723

8,29

3322

Build

ing In

dustr

y M

edica

l Aid

Fu

nd (E

aste

rn C

ape)

1893

2177

-13

4060

3610

1217

913

829

3064

3168

-313

512

111

883

908

-339

3512

12(1

21)

110

7-6

611

00,3

0-3

,3633

02Bu

ilding

Indu

stry

Med

ical A

id

Fund

(Wes

tern

Cap

e)11

580

961

1105

1207

410

447

1687

906

-90

7878

8806

-11

5776

4-9

326

7828

07-5

1924

3-9

236

7217

9810

431

716

691

30,41

17,21

3304

Clot

hing

Indu

stry

Hea

lth

Care

Fun

d (C

ape T

own)

8649

953

482

6229

094

2857

12

2845

-37

1515

1488

21

2-3

719

894

1760

913

1927

-30

2418

033

656

-28

266

370

-28

83,11

117,8

033

27Cl

othin

g In

dustr

y M

edica

l Be

nefit

Sch

eme

(Fre

e St

ate

& N

othe

rn C

ape)

539

499

826

326

40

4144

-822

923

0-1

3538

-848

3252

75

4050

543

915

930

821

1319

1,78

166,3

433

39Cl

othin

g In

dustr

y M

edica

l Be

nefit

Soc

iety (

Nor

ther

n Are

as)

6327

7271

-13

3936

4346

-952

504

3259

3271

043

3715

741

623

1910

737

2165

2248

-434

230

711

55,00

51,73

3318

Clot

hing

Indu

stry

Sick

Bene

fit

Fund

(Nat

al)16

826

1680

30

1131

210

532

756

527

4040

5550

-27

2028

-27

3969

3515

1320

1713

1401

711

522

2284

065

429

123,9

210

9,40

3419

Knitt

ing In

dustr

y M

edica

l Be

nefit

Soc

iety (

Nor

ther

n Are

as)

539

814

-34

251

369

-32

3938

214

628

7-4

923

29-2

352

54-5

86

4421

0018

6013

3941

2831

3983

8,28

503,3

533

24M

otor

Indu

stry

Med

ical A

id

Fund

(MIM

ED)

5382

450

178

745

9141

4236

388

711

704

139

4209

3513

5912

610

584

527

421

2625

94

4244

-322

6840

1735

3431

4214

3458

2249

,4140

,9634

79N

atal

Furn

iture

Wor

kers

Sick

Be

nefit

Soc

iety

1466

7635

-81

2086

2066

111

923

426

993

928

756

1045

710

5241

415

460

512

2321

1918

3515

1445

240

501

101,5

988

,8233

14N

atal

Hair

dres

sers

Sick

Ben

efit

Fund

788

788

048

871

8-3

252

76-3

249

541

519

5244

1915

302

-95

232

-95

510

553

-864

870

2-8

104,5

677

,03

TOTA

L BA

RGA

ININ

G C

OU

NC

IL

SCH

EMES

2448

3220

3309

2067

9478

6036

2213

231

247

-754

6465

4855

4213

186

199

-770

758

6650

26

2427

-12

4355

4436

7003

1917

2114

5119

64,10

60,80

Note

s:•

PM

SA =

Per

son

al M

edic

al S

avin

gs A

cco

un

t•

GC

I =

Gro

ss C

on

trib

uti

on

In

com

e•

PAB

PM

= P

er A

vera

ge B

enef

icia

ry P

er M

on

th•

PB

= P

er B

enef

icia

ry


ANNEXURE T5

Deta

iled

fina

ncia

l re

sult

s: b

arga

inin

g co

unci

l sc

hem

esfo

r th

e ye

ar e

nded

31

Dece

mbe

r 20

04Detailed financial results: bargaining council schemes

• The following medical schemes changed their names during 2004:

Ref no. New name Old name With effect from

1487 The Holcim South Africa

Medical Scheme Alpha Group Medical Scheme 2-Feb-04

1042 Mascom Medical Scheme Chamber of Mines Medical Aid Society 1-Jul-04

1115 Biz Health Medical Scheme Johannesburg Metropolitan Chamber of Commerce 1-Jul-04

1579 Southern Sun Medical Aid Scheme Tsogo Sun Group Medical Scheme 1-Sep-04

1589 Baymed Co-ordinated Health Plan 24-Nov-04

• The following amalgamations took place during 2004:

Ref no. Name Scheme amalgamated with Ref no: With effect from

1496 Allcare Medical Aid Scheme NBC Medical Scheme 1170 1-Jan-04

1503 Anglogold Medical Scheme Discovery Health Medical Scheme 1125 1-Jun-04

1148 Myhealth Medical Scheme Oxygen 1215 1-Jul-04

1089 Billmed Medical Scheme Samancor Health Plan 1557 1-Jul-04

• The following medical schemes were wound up during 2004:

Ref no. Name

1177 Highveld Medical Scheme

• The following medical schemes began operations during 2004:

Ref no. Name With effect from

1596 Eclipse Medical Scheme 1-Apr-04

1597 Umvuzo Health Medical Scheme 1-Jul-04

1589 Baymed (registered in 2001) 1-Nov-04

• The following schemes submitted draft financial statements:

Ref no. Name

1537 Hosmed Medical Aid Scheme

3456 Autoworkers Medical Aid Fund (Automed)

3514 Bargaining Council for the Building Industry (Kimberly)

3304 Clothing Industry Health Care Fund (Cape Town)

3327 Clothing Industry Medical Benefit Scheme (Free State & Nothern Cape)

3339 Clothing Industry Medical Benefit Society (Northern Areas)

3318 Clothing Industry Sick Benefit Fund (Natal)

3419 Knitting Industry Medical Benefit Society (Northern Areas)

3479 Natal Furniture Workers Sick Benefit Society

3314 Natal Hairdressers Sick Benefit Fund


ANNEXURES5Explanatory notes to the annexures

• Projections were made in respect of the non-financial data with regards to the following

schemes:

Ref no. Name

3456 Autoworkers Medical Aid Fund (Automed)

3302 Building Industry Medical Aid Fund (Western Cape)

3318 Clothing Industry Sick Benefit Fund (Natal)

3324 Motor Industry Medical Aid Fund (MIMED)

3479 Natal Furniture Workers Sick Benefit Society

3314 Natal Hairdressers Sick Benefit Fund

• The 2003 comparative figures have been restated for the following schemes as a result of:

Ref no. Name Reason

1534 Altron Medical Aid Scheme Specific reserves transferred to accumulated funds

1012 Anglo American Corporation Medical

Scheme (AACMED) Reclassification

1593 Built Environment Professional

Associations Medical Scheme (BEPS) Reclassification

1202 Fedhealth Reclassification

1086 Food Workers Medical Benefit Fund Change in accounting policy

1162 Global Health Reclassification

1559 Imperial Group Medical Scheme Specific reserves transferred to accumulated funds

1576 Liberty Medical Scheme Reclassification

1495 Massmart Health Plan Reclassification

1560 Openplan Medical Scheme Reclassification

1583 Platinum Health Reclassification

1454 Pro Sano Medical Scheme Consolidation

1516 Quantum Medical Aid Society Change in accounting policy

1430 Remedi Medical Aid Scheme Reclassification

1209 SA Breweries Medical Aid Society Reclassification

1531 Sedmed Restatement

1422 Topmed Medical Scheme Reclassification

1582 Transmed Medical Fund Reclassification

1291 Witbank Coalfields Medical Aid Scheme Reclassification

1293 Wooltru Healthcare Fund Specific reserves transferred to accumulated funds

Although Klerksdorp Medical Benefit Society (KDM) submitted consolidated accounts for 2004,

the 2003 comparatives were not restated.

• Please take note that the figures were rounded off in the report; hence the percentage vari-

ance will be different to that in the Annexures

• Bargaining Council Schemes were formerly known as Exempt Schemes


ANNEXURES5

Explanatory notes to the annexures continued

Produced by the Council for Medical Schemes,

Designed by Shahn Irwin


council formedical schemes reports/2004-2005 cms annu… · by colin richards) and comes from the...

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