annual report to members 2013

Transcription

1 annual report to members 2013

2 your health is your wealth

3 contents 2 Principal Officer s Report to Members 5 Report of the Board of Trustees 20 Report of the Independent Auditors 22 Summarised Annual Financial Statements

4 Momentum Health Principal Officer s Report to Members for the year ended 31 December 2013 It gives me pleasure to report that 2013 proved to be yet another remarkable year for Momentum Health in terms of membership growth, financial performance and in providing access to cost efficient world-class healthcare to our Members. Healthy medical scheme The private healthcare sector, in its current form, is a challenging environment for medical schemes to operate in, and this has resulted in a large degree of medical scheme consolidation. Amalgamations and liquidations have halved the number of open medical schemes in the market over the past decade; this trend is not expected to slow down in the near future. With the Risk Equalisation Fund project now formally called off, survival of medical schemes with less desirable risk profiles is becoming increasingly difficult. 7 % GROWTH Momentum Health s story has however been unique, and the Scheme continues to attract a desirable membership profile. On-going favourable membership growth and increasing uptake of the Scheme s innovate solutions, is evidence of market appreciation for its focussed approach to resolving issues within the current healthcare funding environment. Momentum Health s membership grew by just over 7%, ending 2013 with families now part of the Momentum Health story. This should enable the Scheme to easily retain its position as the third largest open medical scheme in the country. Perhaps, more important than the extent of membership growth, is the risk that these new Members introduce into the Scheme s risk pool. Ideally new Members should be younger and healthier than the existing risk pool to counter the effect of the existing Members naturally aging year on year. As the general population ages so does the open medical scheme environment but fortunately, this has not been the case with Momentum Health. For the last number of years, and again in 2013, the risk profile of the Scheme has improved. The Principal Member average age is now at a healthy 42.6 years, where the open scheme industry < families + > average is progressing beyond the 45 year mark. Although the required statutory solvency ratio was comfortably attained by Momentum Health in 2012, Member 2 Momentum Health Principal Officer s Report to Members for the year ended 31 December 2013

5 Average Member Age YEARS reserves were once again boosted by a surplus of R143.8 million in High membership growth impacts the solvency ratio negatively due to the fact that three months of contributions (25% of annual contributions) are required to be held in reserves before the first contribution has actually been received by the Scheme. Despite the high levels of growth experienced, solvency levels have grown further to 31.0% at the end of With reserves now of R837.7 million at the end of 2013, Members can have peace of mind, knowing that the Scheme s claims paying ability is very strong Membership Solvency % Principal Officer s Report to Members for the year ended 31 December 2013 Momentum Health 3

6 We believe that your health is your wealth The quote by AJ Reb Materi, So many people spend their health gaining wealth, and then have to spend their wealth to regain their health, supports Momentum Health s philosophy that your health plays the most important role in your wealth story. Without health, wealth is meaningless or unachievable. Momentum Health continues to advocate various elements of pro-active health care management in support of improved health outcomes and these have been built into the Scheme s benefit design strategy, namely early detection of possible disease, prevention of further development of disease detected in early stages, appropriate treatment of diseases, management of in-hospital events (customised according to each members actual and relevant health and disease situation) and frequent participation in exercise. Members compliance with the processes of the above elements substantially improves appropriateness and quality of care, thereby also reducing the overall cost of care. It is therefore crucially important that Momentum Health continues to partner with its Members by educating them on their current health status and also in providing the tools to improve their health before it is too late. This is mutually beneficial as it results in downstream claims savings for the Scheme, and more importantly, ensures happier, healthier members remaining with a sustainable Scheme. Conclusion 2013 was undeniably a very good year for Momentum Health, but I strongly believe that we are now beginning a new chapter in the Momentum Health story. Never before has the outlook of the Scheme been this positive and the growing influx of new Members is a testament to this. I want to thank everyone that has been part of this story up to now and simultaneously extend a warm welcome to the families that have recently joined, and also to those that will be joining the Momentum Health family in the near future. TJ van den Bergh Principal Officer So many people spend their health gaining wealth, and then have to spend their wealth to regain their health ~ AJ Reb Materi ~ 4 Momentum Health Principal Officer s Report to Members for the year ended 31 December 2013

7 your health is your wealth Momentum Health Report of the Board of Trustees for the year ended 31 December 2013 The Board of Trustees ( Board ), in presenting its report for the year ended 31 December 2013, fully acknowledges its statutory obligations, and the continued well-being of the Scheme and its Members has remained its highest priority during the year. 1. Description of the Medical Scheme 1.1 Terms of Registration Momentum Health, Registration number 1167, is a not for profit open medical scheme registered in terms of the Medical Schemes Act 131 of 1998, as amended (the Act ). 1.2 Benefit Options within Momentum Health During 2013, Momentum Health offered six registered options. These were: Ingwe Access Custom Incentive Extender Summit These six registered options were subdivided into 22 benefit options based on provider choice. In order to provide a facility for Momentum Health Members ( Members ) to set aside funds to meet future healthcare costs not covered by their chosen benefit option, the Scheme has made Personal Medical Savings accounts available to Members belonging to the Incentive and Extender options, whereby members contribute into such accounts a pre-determined percentage of their gross contributions. Unexpended medical savings are accumulated for the long-term benefit of the Member. Amounts due to Members in respect of the Personal Medical Savings account balances are reflected as a liability in the financial statements, repayable in terms of Regulation 10 of the Act. Momentum Health, carries the risk associated with the advance of monies in excess of Members savings contributions received, and in the event of Members leaving the Scheme, these advances are recovered directly from the Members. Report of the Board of Trustees for the year ended 31 December 2013 Momentum Health 5

8 Momentum Health does not charge interest on negative Personal Medical Savings account balances. The Health Platform represents a set of preventative benefits on all benefit options aimed at early detection and diagnosis of illnesses and ailments, which benefits are funded from the Scheme s risk benefits. 1.3 Risk Transfer Arrangements The following risk transfer arrangements were in place during the year under review: Organisation Momentum Medical Scheme Administrators (Pty) Ltd (MMSA) Momentum Medical Scheme Administrators (Pty) Ltd (MMSA) Traumalink (Pty) Ltd (Netcare 911) Services Provided primary healthcare services at healthcare centres and through contracted network service providers for Members on the Ingwe and Access options. Provided Chronic Care Benefits for the 26 Prescribed Minimum Benefits (PMB) Chronic Disease List (CDL) conditions for Members on all options except Ingwe and Access options. Provided emergency transport services and other ambulance services for Members on all options. your health is your wealth 6 Momentum Health Report of the Board of Trustees for the year ended 31 December 2013

9 2. Scheme Management Board of Trustees Attendance at Meetings First elected / appointed Most recently elected / appointed Mr A Robberts: Chairman (^) 6 of 6 31-Jul Jun-12 Mr L Fullarton 6 of 6 26-Jun Jun-11 Mrs Y Kwinana (*) 2 of 2 01-Oct Oct-13 Ms T Mahuma 6 of 6 31-Jul Jun-11 Mr PL Naidoo (*) 6 of 6 25-Aug Jun-13 Mr S Nkosi 6 of 6 28-Jun Jun-12 Mr GHA Steyn 5 of 6 22-Jul Jun-13 Dr CF Swanepoel 6 of 6 26-Jun Jun-11 Prof BPS van Eck 5 of 6 23-Jun Jun-13 Date resigned Audit Committee Mr M Mia: Chairman 3 of 4 19-Apr Jun-13 Ms CJ Kennedy 4 of 4 01-Oct Jun-13 Mr A Robberts 3 of 4 08-Aug Jun-13 Mr GHA Steyn 3 of 4 22-Jul Jun-13 Mr GP Wayne 4 of 4 24-Aug Jun-13 Investment Committee Mr L Fullarton: Chairman 4 of 4 19-Jan Jun-13 Mr P Davis 0 of 1 01-Oct Oct-13 Mr IY Mahomed 3 of 4 01-Jan Jun-13 Mr HP Meyer 2 of 2 16-Feb Jun Jun-13 Mr A Robberts 4 of 4 28-Jun Jun-13 Mr GHA Steyn (Alternate) 2 of 4 19-Aug Jun-13 Clinical Risk and Governance Committee Dr CF Swanepoel: Chairman 4 of 4 26-Jun Jun-13 Dr H Botha 4 of 4 01-Dec Jun-13 Dr A Mathey 2 of 2 02-Aug Jun Jun-13 Dr A Dearham 1 of 1 01-Oct Oct-13 Governance and Remuneration Committee Mr PL Naidoo: Chairman 4 of 4 26-Oct Jun-13 Ms T Mahuma 3 of 4 28-Jun Jun-13 Mr S Nkosi 4 of 4 26-Jun Jun-13 Prof BPS van Eck 3 of 4 23-Jun Jun-13 ^ The Chairman is elected annually by the Board at its first meeting after the Annual General Meeting. * Trustees appointed by the Board. Note: Members and Chairmen of all Committees are appointed annually by the Board. Report of the Board of Trustees for the year ended 31 December 2013 Momentum Health 7

10 Principal Officer Appointed Ms TJ van den Bergh 01 Aug 05 Registered office and postal address of the Scheme Registered Office 1-3 Canegate Road La Lucia Ridge 4019 Postal Address PO Box 2338 Durban 4000 Administrator Momentum Medical Scheme Administrators (Pty) Ltd, a wholly-owned subsidiary of MMI Group Ltd 1-3 Canegate Road La Lucia Ridge 4019 Administration accreditation number: ADMIN 13 Managed Healthcare accreditation number: MCO 59 Investment Managers Investment Consultants The Applied Group Member of the JSE Securities Exchange Suite 4 Hibicus House Fairway Green Office Park Abrey Road Kloof 3610 Financial Service Provider number: Asset Managers Momentum Asset Management (Pty) Ltd 4 Merchant Place 1 Fredman Drive Sandton 2196 Financial Service Provider number: 623 Consulting Actuaries True South Actuaries and Consultants (Pty) Ltd Principal Bankers First National Bank Auditors Deloitte & Touche 8 Momentum Health Report of the Board of Trustees for the year ended 31 December 2013

11 2.1 Board of Trustees The skills and experience of the current Trustees are outlined below: L Fullarton Les Fullarton holds a B Soc Sc degree. He is a Chartered Secretary (A.C.I.S) and a Certified Financial Planner (CFP ). He currently serves on a number of Retirement Funds as a trustee and principal officer. Y Kwinana Yakhe Kwinana holds BCompt and BCom Hons degrees. She is a Chartered Accountant and has a Diploma in Banking and a higher Diploma in Computer Auditing. She is an expert in the public sector environment where her expertise ranges from external audits and internal audits to financial management. She has handled audits for a number of large public entities including the Auditor General South Africa. T Mahuma Teboho Mahuma holds a BA Honours degree in Social Work as well as an M.Phil (Ethics) degree. She has for many years served in executive and board roles in Not-For-Profit and private sector organisations, and is currently an independent consultant providing advisory and technical services primarily in social development. PL Naidoo Lawson Naidoo holds a LLM degree from Cambridge University in England. He has a broad range of experience in the political, parliamentary as well as business arenas. He is the executive secretary of the Council for the Advancement of the South African Constitution. S Nkosi Solomon Nkosi holds a BBA degree and a MBA. He is currently employed as the Operations Manager at DMS Powders. A Robberts André Robberts holds a BCom Hons degree and is a Chartered Accountant. He is a businessman and director of various companies and is also actively involved in the accounting profession as a Partner in The Ashton CA (SA) Group. GHA Steyn Gert Steyn holds a B Com Accounting degree and a Masters in Business Leadership degree. He has experience in the public health environment, having been responsible for the National Revitalisation Programme. He is currently employed by the Foundation for Professional Development as a Technical Assistant, with specific focus on the implementation of the National Health Insurance System. He is the chief Executive Officer of the Health and Medical Publishing group CF Swanepoel Francois Swanepoel is a medical doctor. He is the Executive Medical Director and Founder of Thandile Health Risk Management, specialising in Health Risk Management, Absenteeism and Ill Health Retirement. BPS van Eck Stefan van Eck holds a LLD degree. He is Head of the Department of Mercantile Law at the University of Pretoria and teaches law at both undergraduate and postgraduate level. He specialises in the field of labour law, contract and general business law. Report of the Board of Trustees for the year ended 31 December 2013 Momentum Health 9

12 3. Sub-Committees of the Board of Trustees The Board has established four Sub-Committees to assist it in its duties. All Sub-Committees meet regularly and consist of both Trustee and non-trustee members who have been appointed for their skills relating to the responsibilities of each Sub-Committee. Each Sub-Committee is mandated by the Board by means of a written Charter as to its membership, authority and duties. The Principal Officer attends all Sub-Committee meetings. The four Board Sub-committees are: Audit Committee Investment Committee Clinical Risk and Governance Committee Governance and Remuneration Committee In addition to the Committees referred to above, a Management Committee, comprising of Scheme Management and Trustees in rotation, meets bi-monthly and is responsible for monitoring of operational issues and risk management. Management Committee meetings are also attended by representatives from the administrator, managed healthcare providers and other third party providers by invitation. 3.1 Audit Committee The Audit Committee is established in accordance with the provisions of the Act. The Audit Committee has five members, two Trustees and three non-trustees. In terms of the Act, the Chairman must be a non-trustee. The main responsibility of the Committee as set out in its Charter is to assist the Board in fulfilling its responsibilities by ensuring that there are adequate and effective: Accounting policies; Internal control systems; Financial reporting standards; and Risk management processes. For the year ended 31 December 2013, the Committee members were: M Mia (Independent member) Chairman CJ Kennedy CA (SA) (Independent member) A Robberts CA (SA) (Trustee member) GHA Steyn B Com MBL (Trustee member) GP Wayne CA (SA) (Independent member) 10 Momentum Health Report of the Board of Trustees for the year ended 31 December 2013

13 The Principal Officer, in terms of her mandate from the Board, the internal auditors of the Administrator and the external auditors of the Scheme, by invitation, attended all Audit Committee meetings and have unrestricted access to the Chairman of the Audit Committee. Meetings are held with both the external and internal auditors on a regular basis to ensure that matters are considered without undue influence. Based on a review of management and audit reports, appropriate discussion and enquiry by the members, the Committee carried out all duties set out in its Charter. The Audit Committee has brought no item or event to the attention of the Trustees that indicates any material breakdown in the functioning of the key internal controls and systems during the year under review. The Audit Committee met four times during the year and the details of individual membership and attendance are set out in section Investment Committee The investment objectives of the Scheme are to maximise the return on its investments on a long term basis at minimal risk. The investment strategy takes into account both constraints imposed by legislation and the mandate approved by the Board. For the year ended 31 December 2013, the Committee members were: L Fullarton BSocSc ACIS CFP (Trustee member) Chairman Pieter Davis BCom (Hons) MBA (Independent member) IY Mahomed B.Sc (Hons) Actuarial Science (Independent member) A Robberts CA (SA) (Trustee member) HP Meyer BCom Econometrics (Independent member) (resigned 20 June 2013) GHA Steyn BCom MBL (Trustee member - alternate) Report of the Board of Trustees for the year ended 31 December 2013 Momentum Health 11

14 The overall objective of the Investment Committee is to assist the Board to fulfil its responsibilities relating to the: Preparation and continuous review and evaluation of the strategy for investing the Scheme s assets taking into consideration the surplus funds available; Identification and appointment of investment professionals to whom investment functions will be outsourced; Review and assessment of the risks and returns of investment opportunities; Monitoring of investment performance against established benchmarks; and Monitoring compliance with all relevant legislation. The Scheme continued to utilise the expertise of The Applied Group for investment consulting, development and continuous evaluation of the Scheme s investment strategy and assistance with the appointment of appropriate asset managers. During 2013, the Scheme utilised the services of Momentum Asset Management (Pty) Ltd as the Scheme s asset managers. The management of cash and cash equivalents other than those held by the asset managers was managed by the Scheme s Administrator during The Scheme closed the year with negligible exposure to assets other than cash and near cash products, reflecting the unattractive valuations in both equity and bond markets, corresponding heightened risks prevalent in those markets and continued expectations of inflationary pressures ahead in the new year. Returns for the year were in line with a domestic cash portfolio, as expected. The Board anticipates continuing with its risk averse stance until such time as stability returns to asset markets and valuations normalise at more attractive levels. The Investment Committee met four times during the year, the details of individual membership and attendance are set out in section 2. The Committee carried out all duties set out in its Charter. 3.3 Clinical Risk and Governance Committee The overall objective of the Clinical Risk and Governance Committee is to assist the Board in discharging its duties relating to ensuring continuous improvement in the quality of clinical care, which includes the oversight responsibility regarding: Key strategic and operating issues pertaining to the quality of clinical care; Development and implementation of a clinical governance strategy for the Scheme; Assessment and evaluation of the execution of the clinical governance strategy and implementation plan by the managed healthcare provider; Confirmation that clinical governance principles and service level agreements are inherent in all relevant contracts with providers and designated service providers; and Identification and implementation of suitable best practice interventions taking cognisance of the necessity to manage risk at all times. 12 Momentum Health Report of the Board of Trustees for the year ended 31 December 2013

15 For the year ended 31 December 2013, the committee members were: CF Swanepoel MBChB (Trustee member) Chairman H Botha MSc PhD (Independent member) A Dearham MBChB (independent member) A Mathey MBChB (Independent member) (resigned 20 June 2013) The Clinical Risk and Governance Committee met four times during the year, the details of individual membership and attendance are set out in section 2. The Committee carried out all duties set out in its Charter. 3.4 Governance and Remuneration Committee The Governance and Remuneration Committee is mandated by the Board to provide guidance to the Board in all matters relating to its stewardship of the Scheme, proposals as to Board size and composition, the compensation of Trustees and Committee members and the evaluation of the performance and the remuneration of the Principal Officer. The overall objective of the Governance and Remuneration Committee is to assist the Board in fulfilling its responsibilities relating to: Corporate governance in general, by ensuring the Board has appropriate policies and procedures for Trustees to carry out their duties with due diligence and in compliance with all legal and regulatory requirements; The establishment, composition and responsibilities of Board Sub-Committees; and Procedures for effective Board and Sub-Committee meetings to ensure that the Board functions independently of management and without conflicts of interest. For the year ended 31 December 2013, the Committee members were: PL Naidoo LLM (Trustee member) - Chairman T Mahuma M.Phil (Ethics) (Trustee member) S Nkosi MBA (Trustee member) BPS van Eck LLD (Trustee member) The Governance and Remuneration Committee met four times during the year, the details of individual membership and attendance are set out in section 2. The Committee carried out all duties set out in its Charter. Report of the Board of Trustees for the year ended 31 December 2013 Momentum Health 13

16 4. Management of Insurance Risk The primary insurance activity carried out by the Scheme is that of assuming the risk of certain claims costs from Members and their Dependants as these relate to their health. As such, the Scheme is exposed to the risk of uncertainty surrounding the timing and severity of claims. The Scheme manages its insurance risk through approval procedures for claims that involve pricing guidelines, pre-authorisation, case management, benefit limits and sub-limits, service provider profiling, centralised management of risk transfer arrangements and the monitoring of issues that may impact on risk. The Scheme uses several methods to assess and monitor insurance risk exposures both for individual types of risks insured and overall risks. These methods include internal risk management models, sensitivity analyses and scenario analyses. The theory of probability is applied to the pricing and provisioning for the timing and severity of claims costs within the portfolio of insurance contracts. The principal risk is that the frequency and severity of claims are greater than expected. Insurance events are by their nature random, and the actual number and size of events during any one year may vary from those estimated by using statistical techniques. There are no changes to assumptions used to measure insurance assets and liabilities that have a material effect on the Annual Financial Statements and there are no terms and conditions of insurance contracts that have a material effect on the amount, timing and uncertainty of the Scheme s cash flow. 5. Review of Activities The Board would like to bring the following aspects of the accompanying Annual Financial Statements to your attention. 5.1 Membership The Scheme experienced a 7% growth in membership during the year under review. Membership as at 31 December (2012: ) Lives covered as at 31 December (2012: ) Average age of membership has decreased to years (2012: years) Average age of new Members joining in years (2012: years) Average age of new Beneficiaries joining in years (2012: 28.13) 14 Momentum Health Report of the Board of Trustees for the year ended 31 December 2013

17 The total membership per benefit option was as follows: Benefit Option Principal Members 31 December 2013 Beneficiaries 31 December 2013 Principal Members 31 December 2012 Beneficiaries 31 December 2012 Ingwe Access Custom Incentive Extender Summit Total membership The Board, in conjunction with the Principal Officer, Administrator and advisers, continues to focus on the holistic product offering provided to Members in order to ensure the continued and sustainable growth of the Scheme s membership. 5.2 Financial performance Having continued its focused strategy on optimal health risk management, appropriate membership growth and reducing administration costs, the Board is pleased to report that the Scheme s statutory solvency ratio is 31.0% in The Scheme experienced a continued improvement in its net surplus, after investment returns, and ended 2013 with a R143.8 million surplus (2012: R173.9 million). The Scheme continued its strategic focus on sustainable growth during 2013, and the competitive pricing strategy implemented over the past number of years in order to attract the appropriate Members has again resulted in the average age of Members reducing from years in 2012 to years in Some of the key indicators to consider for the year under review are as follows: Description Gross contribution income R2 699m R2 424m Gross contribution income per member per month R2 080 R2 001 Gross contribution income per beneficiary per month R1 059 R1 010 Risk contribution income per member per month R1 898 R1 812 Risk contribution income per beneficiary per month R966 R914 Relevant healthcare expenditure per member per month R1 509 R1 412 Relevant healthcare expenditure per beneficiary per month R768 R712 Claims ratio based upon risk contributions 79.5% 77.9% Non-healthcare costs per member per month R309 R290 Non-healthcare costs per beneficiary per month R157 R146 Non-healthcare costs as percentage of gross contribution income 14.9% 14.5% Total Members funds R837.7m R693.9m Accumulated funds ratio (excluding unrealised gains) 31.0% 28.6% The operational statistics for each option are provided in Note 27 of the Annual Financial Statements. Report of the Board of Trustees for the year ended 31 December 2013 Momentum Health 15

18 5.3 Accumulated funds Movements in the Accumulated Funds are set out in the Statement of Changes in Funds and Reserves as reflected in the Annual Financial Statements. 5.4 Outstanding claims Movements in the outstanding claims provision are set out in Note 7 to the Annual Financial Statements. 6. Sustainability As at 31 December 2013, the Scheme s accumulated funds ratio was 31.0%. The Board continues to consider Momentum Health s future Risk Based Capital requirements and the Scheme s actuarial consultants assess the Scheme s future Risk Based Capital requirement in order to provide the Board with comfort that Momentum Health remains sustainable. The result of the 31 December 2013 assessment has once again confirmed the Scheme s strong capital position. The Trustees assure Members that the Scheme s sustainability is their primary focus and although the Scheme has attained the required statutory solvency ratio, they will continue to monitor experience against the sustainability strategy and business plan and will continue to develop initiatives to ensure that the Scheme remains sustainable into the future. The accumulated funds ratio is calculated on the following basis: R'000 R'000 Total Members' funds per Statement of Financial Position including unrealised gains Less: Cumulative net unrealised gain on re-measurement to fair value of investments Gross contribution income Members' funds / Gross annual contribution income x 100% including unrealised gains 31.0% 28.6% excluding unrealised gains 31.0% 28.6% The Scheme received an improved rating of AA- in 2013 from the South African Global Credit Rating Company (GCR). This is further evidence of the Scheme s sustainability, as the rating denotes a sound claims paying ability. 16 Momentum Health Report of the Board of Trustees for the year ended 31 December 2013

19 7. Actuarial Services Momentum Health utilises the expertise of the Momentum Group Health actuarial team for actuarial support. These actuaries analyse claiming patterns, monitor the timing and severity of claims and advise on the determination of contributions and benefit levels. The Scheme has also contracted the services of external consulting actuaries, True South Actuaries and Consultants (Pty) Ltd, for ongoing independent actuarial advice and support. 8. Subsequent Events No material events have occurred subsequent to the end of the accounting period to the date of this report that affect the Annual Financial Statements, and that the Trustees consider should be brought to the attention of the Members of the Scheme. 9. Related Party Transactions Refer to related parties and Trustee remuneration disclosures in Note 18 and 19 to the Annual Financial Statements. 10. Investments in and Loans to Members of the Scheme and to other Related Parties Consistent with the Act, the Scheme does not grant loans to Members or any related parties, and confirms that no such loans have been granted. 11. Non Compliance Matters 11.1 Sustainability of Benefit Options In terms of section 33(2) of the Act, each option shall be self-supporting in terms of membership and financial performance and be financially sound. As at 31 December 2013 the Summit option did not meet this requirement. Sections 5 and 6 provide further information on the Scheme s financial performance and sustainability Collection of Contributions In terms of the Act, all contributions should be collected within three days of them being due. During the course of 2013, not all contributions billed were received within three days of the due date, as a result of Members not paying their contributions within the required period. The financial risk is mitigated by the Scheme s stringent credit control policy and processes which minimises the risk of non-recoverability. The management of the contributions collections is an on-going process involving interaction with the employer groups, brokers and Members. Report of the Board of Trustees for the year ended 31 December 2013 Momentum Health 17

20 11.3 Payment of Member Claims In terms of the Act, all claims are required to be paid within 30 days of receipt. Of the total claims received, 99.99% of claims were paid within 30 days of receipt but due to certain procedures to validate claims, such as clinical auditing, there were exceptions where claims were only paid after 30 days of receipt. The claims paid outside of 30 days are investigated by the Scheme in conjunction with the Administrator to ensure effective management 11.4 Investments non-compliance In terms of Category 3 of Annexure B, only 10% of total assets are allowed to be invested in Property. As a result of a change in the categorisation of certain instruments, the underlying property investments in the Scheme s cash equivalents became non-compliant with this requirement with a total of 10.6% invested in property at the end of quarter 2. The Scheme was compliant again since July Investment in administrator In terms of Section 35 (8)(c) of the Act, a medical scheme shall not invest any of its assets in any medical scheme administrator or a holding company of a medical scheme administrator. In 2013, the Scheme held investments in Sanlam Life Insurance Limited, which is a holding company of a medical scheme administrator. The holdings are held as part of a balanced, externally managed fixed income portfolio. The investment decisions on this portfolio are applied across a number of other independent investment portfolios, resulting in lower management and reporting costs for all clients of the manager. The investments are not directly in medical scheme administrators, but in listed bonds of Life Insurers and as such are far removed from the medical scheme environment. The Scheme made application to the Council for Medical Schemes for an exemption from this section of the Act and received such exemption. your health is your 18 Momentum Health Report of the Board of Trustees for the year ended 31 December 2013

21 12. Conclusion The upward turn in Momentum Health s financial position is positive and a clear indication of the success of the Scheme s focused long term strategy of optimal health risk management and appropriate membership growth. A Robberts (Chairman) L Fullarton (Trustee) TJ van den Bergh (Principal Officer) 17 April 2014 wealth Report of the Board of Trustees for the year ended 31 December 2013 Momentum Health 19

22 Report of the Independent Auditors on the Summary Financial Statements to the Members of Momentum Health The accompanying summary financial statements, which comprise the summary statement of financial position as at 31 December 2013, the summary statement of comprehensive income, summary statement of changes in funds and reserves and summary statement of cash flows for the year then ended, and related notes, are derived from the audited financial statements of Momentum Health for the year ended 31 December We expressed an unmodified audit opinion on those financial statements in our report dated 17 April Those financial statements, and the summary financial statements, do not reflect the effects of events that occurred subsequent to the date of our report on those financial statements. The summary financial statements do not contain all the disclosures required by International Financial Reporting Standards. Reading the summary financial statements, therefore, is not a substitute for reading the audited financial statements of Momentum Health. Trustees Responsibility for the Summary Financial Statements The trustees are responsible for the preparation of a summary of the audited financial statements in accordance with Circular 6 of 2013 issued by the Council for Medical Schemes. 20

23 Auditor s Responsibility Our responsibility is to express an opinion on the summary financial statements based on our procedures, which were conducted in accordance with International Standard on Auditing (ISA) 810, Engagements to Report on Summary Financial Statements. Opinion In our opinion, the summary financial statements derived from the audited financial statements of Momentum Health for the year ended 31 December 2013 are consistent, in all material respects, with those financial statements, in accordance with Circular 6 of 2013 issued by the Council for Medical Schemes Deloitte & Touche Registered Auditor Per B. Botes CA (SA) Partner 17 April

24 Momentum Health Summarised Annual Financial Statements for the year ended 31 December 2013 Statement of Comprehensive Income for the year ended 31 December R 000 R 000 Risk contribution income Relevant healthcare expenditure ( ) ( ) Net claims incurred ( ) ( ) Risk claims incurred ( ) ( ) Third Party claim recoveries Net expense on risk transfer arrangements (33 257) (16 728) Risk transfer arrangement fees paid ( ) ( ) Loss share from risk transfer arrangement (932) (772) Recoveries from risk transfer arrangements Gross healthcare result Managed care: management services (58 619) (55 419) Administration expenditure ( ) ( ) Acquisition, marketing and servicing costs ( ) (88 765) Net impairment losses on healthcare receivables (2 466) (4 155) Net healthcare result Other income Investment income Sundry income Other expenditure (7 090) (6 495) Asset management fees (1 822) (1 612) Interest paid on savings accounts (5 268) (4 883) Net surplus for the year Other comprehensive income - - Total comprehensive income for the year Momentum Health Summarised Annual Financial Statements prepared from the Audited Financial Statements for the year ended 31 December 2013

25 Statement of Financial Position at 31 December 2013 Assets R 000 R 000 Current assets Investments held at fair value through profit or loss Scheme Personal medical savings account trust monies invested Trade and other receivables Cash and cash equivalents Total assets Funds and Liabilities Members funds Accumulated funds Current liabilities Personal Medical Savings account trust monies managed by the Scheme on behalf of its members Trade and other payables Outstanding claims provision Total funds and liabilities Summarised Annual Financial Statements prepared from the Audited Financial Statements for the year ended 31 December 2013 Momentum Health 23

26 Statement of Changes in Funds and Reserves for the year ended 31 December 2013 Total Members Funds R 000 Balance at 1 January Total comprehensive income for the year Balance at 31 December Total comprehensive income for the year Balance at 31 December Statement of Cash Flows for the year ended 31 December 2013 Cash flows from operating activities R 000 R 000 Cash from operations before working capital changes Working capital changes Decrease in trade and other receivables Increase in savings plan liability (Decrease) / Increase in trade and other payables (14 735) Increase / (decrease) in outstanding claims provision (126) Cash from operations Interest paid on savings plan accounts (5 268) (4 883) Net cash generated from operating activities Cash flows utilised in investing activities Purchase of investments ( ) ( ) Proceeds on disposal of investments Interest and dividend income Asset management fees (1 822) (1 612) Net cash utilised in investing activities ( ) ( ) Net decrease in cash and cash equivalents (26 882) ( ) Cash and cash equivalents at beginning of the year Cash and cash equivalents at end of the year Momentum Health Summarised Annual Financial Statements prepared from the Audited Financial Statements for the year ended 31 December 2013

27 Basis of preparation The audited financial statements, from which these summarised financial statements are derived, have been prepared in conformity with International Financial Reporting Standards (IFRS) and in the manner required by the Medical Schemes Act 131 of 1998, as amended (the Act). The principal accounting policies used by the Scheme are consistent with those of the previous year. Where necessary, comparative figures have been adjusted to conform with International Financial Reporting Standards. There are certain new accounting standards and interpretations in issue that are not yet effective. The Trustees have considered all of these standards and interpretations and believe they will have no impact on the Scheme. Key Operational Statistics Principal membership at 31 December Beneficiaries at 31 December Average age of principal members 42,58 42,73 Average age of beneficiaries 33,04 33,08 Pensioner ratio (beneficiaries > 65 years) 8,2% 8,1% Beneficiaries per member 1,96 1,98 Non-healthcare expenses as a % of gross contribution 14,9% 14,5% Accumulated funds ratio 31,0% 28,6% Contingent assets The Scheme has potential recoveries of approximately R38.4 million (2012: R37.6 million) outstanding from the Road Accident Fund (RAF). The general likelihood of recovery of these amounts is not considered certain, and the Trustees have elected not to recognise a debtor on the Statement of Financial Position as any future recoveries are highly contingent on a multitude of factors. The Trustees consider, based on past experience and the current financial stability of the RAF, that the receivable, were it to be recognised, would be fully impaired. Subsequent Events No events have occurred subsequent to the end of the accounting period that affect the annual financial report, and that the Trustees consider should be brought to the attention of the Members of the Scheme. Summarised Annual Financial Statements prepared from the Audited Financial Statements for the year ended 31 December 2013 Momentum Health 25

28 Compliance with the Medical Schemes Act There were no significant deviations from the Act. The following matters of non-compliance with the Act were noted: 1. Not all contributions billed are received within 3 days of the due date as required by the Act. Any material financial risk is mitigated by the credit control policies which minimise the risk of non-recoverability. 2. Claims are generally paid within 30 days of receipt but due to certain procedures, such as clinical auditing, there are exceptions where certain claims are only paid after 30 days of receipt. 3. The Summit option incurred operational deficits, whereas the Act requires that all benefit options are self-supporting and financially sound. 4. In terms of Category 3 of Annexure B, only 10% of total assets are allowed to be invested in Property. As a result of a change in the categorisation of certain instruments, the underlying property investments in the Scheme s cash equivalents became non-compliant with this requirement with a total of 10.6% invested in property at the end of quarter 2. The Scheme was compliant again since July In terms of Section 35 (8)(c) of the Act, a medical scheme shall not invest any of its assets in any medical scheme administrator or a holding company of a medical scheme administrator. In 2013, the Scheme held investments in Sanlam Life Insurance Limited, which is a holding company of a medical scheme administrator. The holdings are held as part of a balanced, externally managed fixed income portfolio. The investment decisions on this portfolio are applied across a number of other independent investment portfolios, resulting in lower management and reporting costs for all clients of the manager. The investments are not directly in medical scheme administrators, but in listed bonds of Life Insurers and as such are far removed from the medical scheme environment. The Scheme made application to the Council for Medical Schemes for an exemption from this section of the Act and received such exemption. Related Parties Momentum Medical Scheme Administrators (Pty) Ltd member employers of the Scheme received market related administration, managed care: management services and distribution fees. The Trustees of the Scheme are considered to be key management personnel. Contributions billed to, contributions received from, and claims paid in respect of Trustees of the Scheme during the period, were done in accordance with the Rules of the Scheme and the provisions of the Act. 26 Momentum Health Summarised Annual Financial Statements prepared from the Audited Financial Statements for the year ended 31 December 2013

29 Net Expense on Risk Transfer Arrangements R 000 R 000 Netcare Direct Managed Healthcare (Pty) Ltd (Medicross) Prime Cure (Pty) Ltd Traumalink (Pty) Ltd (Netcare 911) Momentum Medical Scheme Administrators (Pty) Ltd: Primary Care Network Carecross Health (Pty) Ltd - (376) Momentum Medical Scheme Administrators (Pty) Ltd Netcare Direct Managed Healthcare (Pty) Ltd (Medicross), Prime Cure (Pty) Ltd and Carecross Health (Pty) Ltd provide primary care to Members on the particular benefit options of the Scheme within their facilities and contracted facilities nationwide. In 2013, the agreements with Netcare Direct Managed Healthcare (Pty) Ltd (Medicross), Primecure (Pty) Ltd and Carecross Health (Pty) Ltd were terminated and the Scheme entered in a risk transfer arrangement with Momentum Medical Scheme Administrators (Pty) Ltd to provide these primary care services. Traumalink (Pty) Ltd (Netcare 911) provide a capitated ambulance service for Members on all options. The Scheme entered into a risk transfer agreement with Momentum Medical Scheme Administrators (Pty) Ltd whereby Momentum Medical Scheme Administrators (Pty) Ltd provided chronic care benefits for the 26 Prescribed Minimum Benefit Chronic Disease List conditions for Members on all options, except Ingwe and Access options. Investment Income Interest income: Financial investments at fair value through profit or loss R 000 R Cash and cash equivalents Personal medical savings account trust monies invested Financial investments at fair value through profit or loss Net gains or losses on financial assets at fair value through profit or loss realised losses (22 828) (9 121) unrealised gains Personal medical savings account trust monies invested realised losses (77) - unrealised gains Summarised Annual Financial Statements prepared from the Audited Financial Statements for the year ended 31 December 2013 Momentum Health 27

30 Risk Contribution Income R 000 R 000 Gross contributions Less: Savings contributions ( ) ( ) Risk contribution income Administration Expenditure R 000 R 000 Administrator's fees Auditor's remuneration Board of Healthcare Funders (BHF) subscriptions Consultants fees Fidelity and professional indemnity Principal Officer remuneration and related expenses Publication costs Registrar's levies Salaries costs Total trustees and committee members remuneration and consideration expenses Global Credit Rating subscriptions International travel benefit administration fees Debt collection fees Other expenses Outstanding Claims Provision R 000 R 000 Balance at beginning of year Payments in respect of prior year ( ) ( ) Under / (Over) provision in prior year 482 (12 344) Adjustment for current year Covered by risk transfer arrangements Provision for outstanding claims Momentum Health Summarised Annual Financial Statements prepared from the Audited Financial Statements for the year ended 31 December 2013

31 The outstanding claims provision at year-end is calculated based on the claims originating in 2013 that have either been paid or are still to be paid subsequent to year-end. Since claims data is available for three critical development months after year-end (number of months between claim origination and payment), the unknown portion of the outstanding claims provision is relatively small. Estimates (based on run-off factors) are essentially only required from development month four onwards. The run-off factors used were calculated using the previous years claims data based on the assumption that historical claims development is the best indication of future claims patterns. The method set out above is consistent with that used for Note to Members For a better understanding of the financial position and the results of operations, these Summarised Financial Statements are to be read in conjunction with the audited financial statements from which they were derived, which include all disclosures required. The Annual Financial Statements are available on our website, These Summarised Annual Financial Statements have been prepared in accordance with the requirements of Circular 6 of 2013 issued by the Council for Medical Schemes, and have been reviewed by the Scheme s independent auditors. Registered Office 1-3 Canegate Road La Lucia Ridge 4019 Postal Address PO Box 2338 Durban 4000 Trustees A Robberts (Chairman), L Fullarton, Y Kwinana, T Mahuma, PL Naidoo, S Nkosi, GHA Steyn, CF Swanepoel, BPS van Eck Principal Officer TJ van den Bergh Summarised Annual Financial Statements prepared from the Audited Financial Statements for the year ended 31 December 2013 Momentum Health 29

32 Comprehensive Income / (Loss) from Operations per Benefit Option Summit Ingwe GP/ Pharmacy State Ingwe GP/ Pharmacy Access Custom State Hosptial Custom State Any 2013 R 000 R 000 R 000 R 000 R 000 R 000 Risk contribution income 101,469 6, ,714 99, ,622 83,977 Relevant healthcare expenditure (103,754) (2,841) (129,994) (70,565) (245,649) (50,454) Gross healthcare result (2,285) 3,451 44,720 28, ,973 33,523 Non-healthcare expenditure (8,301) (1,212) (30,306) (13,546) (80,147) (13,450) Net healthcare result (10,586) 2,239 14,414 15,015 60,826 20,073 Net investment and other income 1, ,513 1,838 7,002 1,479 Net surplus/(deficit) (8,823) 2,370 17,927 16,853 67,828 21,552 Other comprehensive income Total comprehensive (loss)/ income for the year (8,823) 2,370 17,927 16,853 67,828 21,552 Incentive State Incentive State Any Incentive Any GP/ Pharmacy Any Incentive Any GP/ Pharmacy Incentive GP/ Pharmacy Any Incentive GP/ Pharmacy R 000 R 000 R 000 R 000 R 000 R 000 Risk contribution income 216, , ,361 83,541 22,626 45,448 Relevant healthcare expenditure (145,371) (168,227) (403,325) (69,695) (19,286) (39,029) Gross healthcare result 70,969 73,781 (2,964) 13,846 3,340 6,419 Non-healthcare expenditure (45,979) (42,782) (58,998) (12,971) (3,452) (7,831) Net healthcare result 24,990 30,999 (61,962) 875 (112) (1,412) Net investment and other income 3,356 3,606 6,495 1, Net surplus/(deficit) 28,346 34,605 (55,467) 2, (638) Other comprehensive income Total comprehensive (loss)/ income for the year 28,346 34,605 (55,467) 2, (638) 30 Momentum Health Summarised Annual Financial Statements prepared from the Audited Financial Statements for the year ended 31 December 2013