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July 2017
Michael Temlett
Head: Client Engagement
Senate Group Conference
Agenda
• South Africa at a glance
• Industry update
• 2016 Annual financial results – open schemes
• Open scheme trends
• Conclusion
South Africa at a glace
The South African picture
• There are over 55 million people living in South Africa
– Only 8.8 million people are registered on a medical
scheme
– 16% of the population
• Spend on Healthcare (public and private) R125 billion
– R59 billion on 84% of the population
– R66 billion on 16% of the population
• The assumption is that the majority of the employed
population is covered in the private sector is inaccurate as
approx 75% of the economically active portion of the
population are using state facilities
Industry update
Industry update
• NHI White paper
– Recently released
– Negative media
– Strong political drivers
– Our view: Universal Coverage is the correct ideal
– Challenges:
• Funding (tax credits)
• Strategic Purchasing and access to Hcare providers
• Affordability of expanded PMB package
– Pvt sector has a role to play – participate
• Expertise, Systems, Technology, Low income solutions
Industry update
• Genesis savings account ruling
– Savings account monies forming part of solvency calc
– Artificially inflates solvency
• Scheme increases into 2017 some of the highest in
almost a decade
• Benefit cuts more prevalent to manage scheme result
– Market tolerance for high % increase is low, therefore
benefits cut
• Financial climate in SA – depressed, depressing
2016 Annual financial results
2016 Financial results
• Class average
• Fresh from our financial roadshow (presently underway
nationally)
• Momentum Health’s performance in the context of our
peers
Membership growth
88861
93096
100936
108108
116147
128681
138109
2010 2011 2012 2013 2014 2015 2016
Source: Momentum Health data and CMS report
-40%
-20%
0%
20%
40%
60%
80%
2010 2011 2012 2013 2014 2015 2016
Momentum Discovery
Bonitas Medihelp
Fedhealth Sizwe
Bestmed Medshield
Growth rate
33.4
33.2
33.1
33
32.9
32.6
32.7
2010 2011 2012 2013 2014 2015 2016
28
30
32
34
36
38
40
42
2010 2011 2012 2013 2014 2015 2016
Momentum Discovery
Bonitas Medihelp
Fedhealth Sizwe
Bestmed Medshield
Source: Momentum Health data and CMS report
Beneficiary age
82%
80%
78%
80%
82%
86%
88%
2010 2011 2012 2013 2014 2015 2016
75%
80%
85%
90%
95%
2010 2011 2012 2013 2014 2015 2016
Momentum Discovery
Bonitas Medihelp
Fedhealth Sizwe
Bestmed Medshield
83%
85%
Source: Momentum Health data and CMS report
Claims ratio
R301
R271
R285
R290
R309
R321
R283
R298
2009 2010 2011 2012 2013 2014 2015 2016
R 180
R 230
R 280
R 330
R 380
R 430
R 480
2010 2011 2012 2013 2014 2015 2016
Momentum Discovery
Bonitas Medihelp
Fedhealth Sizwe
Bestmed Medshield
Non-healthcare costs pmpm
Source: Momentum Health data and CMS report
Total non-healthcare costs
R70m
R118m
R174m
R144m
R86m
R48m
R19.3m
2010 2011 2012 2013 2014 2015 2016
-R 200
-R 100
R 0
R 100
R 200
R 300
R 400
R 500
2010 2011 2012 2013 2014 2015 2016
Momentum Discovery
Bonitas Medihelp
Fedhealth Sizwe
Bestmed Medshield
Net result pmpm
Source: Momentum Health data and CMS report
Net result (including investment income)
R22m
R85m
R134m
R105m
R36m
R(12m)
R(87m)
2010 2011 2012 2013 2014 2015 2016
-R 250
-R 200
-R 150
-R 100
-R 50
R 0
R 50
R 100
R 150
R 200
R 250
R 300
2010 2011 2012 2013 2014 2015 2016
Momentum Discovery
Bonitas Medihelp
Fedhealth Sizwe
Bestmed Medshield
Operating result pmpm
Source: Momentum Health data and CMS report
Operating / Net healthcare
20.2%
23.9%
28.6%
31.0%
31.5%
29.3%
25.6%
2010 2011 2012 2013 2014 2015 2016
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
2010 2011 2012 2013 2014 2015 2016
Momentum Discovery
Bonitas Medihelp
Fedhealth Sizwe
Bestmed MedshieldSource: Momentum Health data and CMS report
Regulatory solvency
• Number of principals – 1 833
• Total accumulated funds – R114.8 million
• Solvency – 105%
• Effective date – 1 July 2017
• Improve Momentum Health’s position
• Although small increase in membership
• Additional accumulated funds improves solvency
Metropolitan Medical Scheme Amalgamation
88861
93096
100936
108108
116147
128681
138109
153161
2010 2011 2012 2013 2014 2015 2016 YTD 2017
Membership as at 1 July 2017
Average age of
new members
35 years
Acknolwedgement
17730
25141
33514
50146
57410
65151
0
10000
20000
30000
40000
50000
60000
70000
2012 2013 2014 2015 2016 YTD 2017
Health4Me OCSACare
Low income solutions
Additional
105 959
in our mining
segment
Scheme trends
Trends impacting key metrics
Disease burden
Average age
Medical tech
cost
Supplier
Induced
demand
Financial
markets
Exchange
rate
Contribution
increases
Benefit
reductions
Age of
beneficiary
Claims
ratio
Growth
Rate
Non-
healthcare
Costs
pm pm
Contribution
pm pm
Solvency
Key metrics
Solvency
Age of
beneficiary
Claims
ratio
Growth
Rate
Non-
healthcare
Costs
pm pm
Contribution
pm pm
Death spiral
Age of
beneficiary
Claims
ratio
Growth
Rate
Non-
healthcare
Costs
pm pm
Contribution
pm pm
Solvency
Healthy spiral
Momentum Health
2008
2012
2016
Claims
Ratio
Growth
Rate
Non-
healthcare
Costs
pm pm
Solvency
Risk
contribution
pm pm
20.0%
10.0%
5.0%
0.0%
55.0%
40.0%
30.0%
25.0%
20.0%
-5.0%
Avg. age of
beneficiary
Discovery Health
2008
2012
2016
20.0%
10.0%
5.0%
0.0%
-5.0%
55.0%
40.0%
30.0%
25.0%
20.0%
Claims
Ratio
Growth
Rate
Non-
healthcare
Costs
pm pm
Solvency
Risk
contribution
pm pm
Avg. age of
beneficiary
Bonitas
2008
2012
2016
Claims
Ratio
Growth
Rate
Non-
healthcare
Costs
pm pm
Solvency
Risk
contribution
pm pm
20.0%
10.0%
5.0%
0.0%
55.0%
40.0%
30.0%
25.0%
20.0%
-5.0%
Avg. age of
beneficiary
Bestmed
2008
2012
2016
Growth
Rate
Non-
healthcare
Costs
pm pm
Solvency
Risk
contribution
pm pm
20.0%
10.0%
5.0%
0.0%
55.0%
40.0%
30.0%
25.0%
20.0%
-5.0%
Claims
Ratio
Avg. age of
beneficiary
2008
2012
2016
Medihelp
Growth
Rate
Non-
healthcare
Costs
pm pm
Solvency
Risk
contribution
pm pm
20.0%
10.0%
5.0%
0.0%
55.0%
40.0%
30.0%
25.0%
20.0%
-5.0%
Claims
Ratio
Avg. age of
beneficiary
2008
2012
2016
Fedhealth
Growth
Rate
Non-
healthcare
Costs
pm pm
Solvency
Risk
contribution
pm pm
20.0%
10.0%
5.0%
0.0%
55.0%
40.0%
30.0%
25.0%
20.0%
-5.0%
Claims
Ratio
Avg. age of
beneficiary
2008
2012
2016
Medshield
Growth
Rate
Non-
healthcare
Costs
pm pm
Solvency
Risk
contribution
pm pm
20.0%
10.0%
5.0%
0.0%
55.0%
40.0%
30.0%
25.0%
20.0%
-5.0%
Claims
Ratio
Avg. age of
beneficiary
2008
2012
2016
Sizwe
Growth
Rate
Non-
healthcare
Costs
pm pm
Solvency
Risk
contribution
pm pm
20.0%
10.0%
5.0%
0.0%
55.0%
40.0%
30.0%
25.0%
20.0%
-5.0%
Claims
Ratio
Avg. age of
beneficiary
Top 8 schemes - 2008
20.0%
10.0%
5.0%
0.0%
-5.0%
55.0%
40.0%
30.0%
25.0%
20.0%
Avg. age of
beneficiary
Growth
Rate
Non-
healthcare
Costs
pm pm
Solvency
Risk
contribution
pm pm
Claims
Ratio
Top 8 Schemes – 2016
20.0%
10.0%
5.0%
0.0%
-5.0%
55.0%
40.0%
30.0%
25.0%
20.0%
Growth
Rate
Non-
healthcare
Costs
pm pm
Solvency
Risk
contribution
pm pm
Claims
Ratio
Avg. age of
beneficiary
Conclusion
Conclusion
• Industry:
– Healthcare industry facing interesting times
– 2016 was a difficult year for medical schemes
– Profile is worsening in our industry
– Benefit reductions are an increasing trend
• Momentum continues to provide:
– Consistent strength in financial performance
– World class service
– Value for consumers
– Market leading low income solutions
– Innovative and flexibile solutions for our intermediaries
Thank you

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