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PPS HEALTHCARE
ADMINISTRATORS
PPS Healthcare Administrators (PPSHA) is a
wholly-owned subsidiary of PPS Insurance that
currently administers three medical aid schemes:
• Profmed: a closed scheme for graduates meeting
certain criteria
• KeyHealth: an open medical scheme servicing
government employees and growing numbers of
private members
• Regular Force Medical Continuation Fund (RFMCF):
a prefunded medical scheme that mainly provides
medical, dental and hospital treatment for retired
members of the South African Defence Force
Each scheme caters to specific needs, allowing us to
tailor-make our health solutions rather than offering
a one-size-fits-all model.
What we do
PPSHA stands apart from our competitors due to our
low-cost, high-service model and proven capability to
manage closed, open and prefunded schemes through
customised solutions.
Member input is critical to accurate decision-making,
therefore each scheme conducts multi-channel surveys,
focus groups and annual benefit review meetings to
address member concerns.
Performance
PPSHA is South Africa’s fourth largest medical schemes
administrator and our fees track within the industry
average range. For the past seven years, PPSHA has
contributed to the member profit share.
KeyHealth and Profmed – our two biggest schemes
– are comfortably above the 25% solvency ratio and
recorded excellent claims ratios.
Our scheme’s non-healthcare expenditure remained
below the Council for Medical Schemes (CMS) 10%
benchmark and Profmed recorded healthy organic
growth in membership.
PPSHA has made significant investments into system
upgrades over the last few years to improve our
efficiencies and increase competitiveness. We are
already reaping the benefits which is evident in our
return on investment (ROI) from recently introduced
technologies.
Although hospital network options introduced by
KeyHealth elicited mixed reactions from members,
it was critical for the scheme to remain competitive
by ensuring affordability of the medical scheme
contributions. KeyHealth has increased benefits to its
members through its enhanced disease management
programme which was received positively.
PPSHA, Profmed and PPS jointly reached out to students
through direct marketing campaigns and reduced fees
overall. Scheme rates are regularly compared to market
averages and our management costs.
We began evaluating alternative reimbursement models
for improving medical scheme financials.
Specialist profiling conducted in conjunction with
the specialist professional bodies has enhanced our
relationships with the medical specialist community.
The RFMCF reacted positively to introducing
hospital networks and plans to introduce hospital
pre-authorisations in 2019.
Risks, challenges and opportunities
Themedical scheme sector remains highly regulated and
intensely competitive with no significant membership
growth. Regulatory changes to solvency and claims
ratio, among others, are compelling medical schemes
to merge, adding to the complexity for PPSHA and
other administrators in acquiring new business for
administration.
At present, 12 administrators are competing for just
80 remaining schemes.
In this period, Profmed has experienced growth in
membership in a challenging environment.
Prospects
We are working diligently with Profmed to retain our best
talent and continue enhancing customer relationships.
We have provided recommendations to the Medical
Schemes Amendment Draft Bill, Council for Medical
Schemes Circular on Consolidation of Medical Schemes,
the Health Market Inquiry and the unfolding National
Health Insurance (NHI) Bill.
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