How Medical Savings Accounts Are Changing – For The Better By Jeremy Yatt, Principal Officer of Fedhealth

The concept of medical savings accounts (MSA) emerged in the industry in the early 1990s, reputedly when Discovery founder Adrian Gore was working at Liberty. At that time medical scheme benefits for different kinds of day-to-day healthcare were specified, so for example, you'd get a certain amount of Rands to spend on your over-the-counter medicine, or for optometry services. But this was problematic, as people's daily medical needs are all so different. So, you'd have medical aid members calling their medical schemes saying, "I haven't used my spectacle limit this year, so can I transfer it to use on medication instead?".

The idea for MSAs was to pool these separate benefits into a total Rand amount, that you could then spend how you wanted, and more importantly, retain if you didn't use them all. Initially, medical schemes were reluctant to follow this idea, as they thought it would lead to under-servicing: medical aid members might be unwilling to spend their savings, and so might not get the proper day-to-day medical attention until it became a crisis and they were hospitalised. However this was not the case, and MSAs proved very popular.

At first, there was no real limit on how much of your contributions as a member could go into your MSA, so most schemes allocated around 40-50%. Many schemes also pushed major medical procedures like MRI scans into savings, which was effectively a way of forcing members to self-fund these costly medical expenses. As a result, the Medical Schemes Act was amended in 1998 to impose a 25% limit on the benefits that could be put into MSAs, which largely forced the schemes to be responsible for these major costs.

Under the previous structure there was no disincentive not to use your benefits, particularly as they didn't roll over from year to year like Medical Savings do. It was therefore not uncommon for a call centre to get queries from members asking how much was available in their different benefit areas, so that they could make sure they used them all up.

MSAs solved these sorts of problems by giving medical aid members increased convenience and autonomy, which is why schemes have been using them for the past 20+ years.

The concept of an MSA isn't far removed from a loan. Like a loan, an MSA lets you use a sum of money when you want to, but you still have to pay for it regardless of whether you use it or not. It forms part of the registered gross contribution to the medical scheme.

Take the example of a member who has R12 000 they can access in their MSA each year. Effectively they are paying for this "loan", contributing R1000 a month, starting in January. However an MSA means they can use all of that R12 000 upfront, such as if they need expensive dental treatment (crowns etc.) at the start of February that costs R12 000.

In this situation, the member has only paid for R1000 worth of that R12 000 "loan" (with their January contribution), so they effectively "owe" the medical scheme R11 000, which they then pay off over the remainder of the year. If the member left the scheme straight after their dental work, the scheme would then contact the member to repay the R11 000, as they still owe that amount.

The concept of giving members access to medical financing led us to develop our new MediVault offering for day-to-day medical expenses. Describing it as a loan holds negative connotations for some, but it's not that different from the concept of an MSA: in fact, we see the MediVault as a natural evolution. All it means is that you won't need to pay for day-to-day savings upfront.

Instead, you'll be allocated money for these everyday medical expenses in your personal MediVault and, once you've taken the money out, you only have to pay it back over a period of 12 months – completely interest-free. This is a far better option than taking out an expensive loan from a traditional loan company, or getting it from an unscrupulous loan shark.

Our MediVault offering is not at all about loaning funds to people irresponsibly. We're not creating a monster that's going to indebt you - we're just changing the way you can access funds for your healthcare. After all, health is everyone's most worthwhile investment, and we want to give people the flexibility to make it their top priority.