QUARTERLY REPORTS. for the period ended 30 September 2006

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2 QUARTERLY REPORTS for the period ended 30 September 2006 Contents Annexure Page 1. Introduction 3 2. Regulation 29 Minimum Accumulated Funds A 7 3. Solvency Ratio Graph B 8 4. Prescribed Solvency Levels and Number of C 9 Members 5. Nett Assets per Regulation 29 Graph D Income Statement Details E Balance Sheet Details F Number of Beneficiaries Graph G Detailed financial information: Actual vs. Budget H Total Non-Health Expenditure Graph I Detailed financial information: Actual vs. Budget J Risk claims ratio: Risk Benefit Graph K 24 COUNCIL FOR MEDICAL Quarterly Report Quarter 3 2

3 INTRODUCTION This report represents the results of the analysis of the quarterly statutory returns for the period ended 30 September Budget information for the third quarter of 2006 is also provided for comparative purposes. This report reflects consolidated industry data only, as data on an individual scheme-level has not been audited and could therefore not be made available to the public. All the annexures exclude bargaining council schemes, due to the unavailability of quarterly information. The following medical schemes changed their names during the period ended 30 September 2006: Anglo American Corporation Medical Scheme (AACMED) changed its name to Anglo Medical Scheme with effect from 1 January NBC Medical Scheme changed its name to Pure Health Medical Scheme with effect from 1 January The following medical schemes were registered during the period ended 30 September 2006: Government Employees Medical Scheme (GEMS) was registered on the 1 st of January 2005 but has only started with operations with effect from 1 January Lonmin Medical Scheme was registered with effect from 1 January The following amalgamations took place during the period ended 30 September 2006: Medical Expenses Distribution Society (MEDS) amalgamated with Oxygen Medical Scheme with effect from 1 January Protector Health s members were transferred to Bonitas Medical Aid Fund with effect from 1 January The amalgamation has been approved on 3 October Klerksdorp Medical Benefit Scheme (KDM) amalgamated with Medicover with effect from 1 July The following schemes were liquidated during the period ended 30 September 2006: Free State Medical Aid Scheme was liquidated with effect from 1 January Eclipse Medical Scheme was liquidated with effect from 1 May COUNCIL FOR MEDICAL Quarterly Report Quarter 3 3

4 Monitoring financial performance and soundness of medical schemes a brief summary of the most important trends Accumulated funds and solvency levels The overall industry average solvency level decreased by 7,2% from the audited solvency level of 39,1% at 31 December 2005 to 36,3% at 30 September The solvency level at 30 September 2006 was 2,5% higher than the budgeted solvency level of 35,4% for the same period. On an industry level, the solvency level exceeded the required minimum level of 25%, as per Regulation 29(1) of the Medical Schemes Act, for both open and restricted schemes. The 18 (2005:18) open schemes that failed to meet the prescribed solvency level at 30 September 2006, represent 64% (2005: 57%) of the total open schemes beneficiaries. Only 7 (2005:6) restricted schemes were below 25%. The nett asset value (per Regulation 29) per beneficiary decreased with 3,5% from R3060,1 at 31 December 2005 to R2954,1 at 30 September The nett asset value per beneficiary at 30 September 2006 was 3,5% lower than the budgeted nett asset value of R3062,0 for the same period. Membership, age distribution and pensioner ratio The total number of principal members of registered medical schemes increased by 4,9% from at 31 December 2005 to at 30 September The number of total beneficiaries increased by 3,2% from at 31 December 2005 to at 30 September The average number of members of for the period ended 30 September 2006 was 3,5% lower than budget, and the average number of beneficiaries of was 1,8% higher than budget. The industry average age for all registered schemes for the period ended 30 September 2006 was 31,7 (2005:31,7) years and the proportion of pensioners, 6,4% (2005:6,4%). COUNCIL FOR MEDICAL Quarterly Report Quarter 3 4

5 Contributions and claims The total gross contribution income for all medical schemes amounted to R42,9 billion for the period ended 30 September 2006, 2,3% lower than the budget of R44,0 billion for the same period. The gross contributions per average beneficiary per month of R689,0 for the period ended 30 September 2006 was lower than the budgeted amount of R718,4, which represents a 4,1% variance. Gross claims per average beneficiary per month was R629,5 for the period ended 30 September The gross contributions per average beneficiary per month at 30 September 2006 of R689,0 went up by 2,9% from R669,9 at 31 December Total risk contributions of R38,3 billion, as well as the risk contribution per average beneficiary of R614,7 per month for the period ended 30 September 2006, were lower than budget by 2,5% and 4,3% respectively. The nett claims ratio of 89,3% at 30 September 2006 exceeded the budgeted nett claims ratio of 86,2% as well as the nett claims ratio of 84,4% at 31 December The nett claims per average beneficiary per month of R549,0 for the period ended 30 September 2006 was lower than the budgeted amount of R553,2 by 0,8%. The nett claims per average beneficiary per month of R549,0 at 30 September 2006 increased by 9,9% from R499,6 at 31 December Total nett claims for the period ended 30 September 2006 was R34,2 billion compared to the budgeted nett claims of R33,9 billion, representing a 1,0% variance. The utilization of the prior year s outstanding claims provision was 105,2% for all schemes as at 30 September Non-health expenses Total gross non-health expenses for all medical schemes amounted to R6,1 billion for the period ended 30 September 2006, which were 2,1% lower than the R6,2 billion budgeted for. The gross non-health expenses per average beneficiary per month of R98,6 was 3,9% lower than the budget of R102,6 for the period ended 30 September 2006, and 2,1% higher than the industry average of R96,6 at 31 December Gross non-health expenses when expressed as a percentage of gross contributions, decreased slightly from 14,4% at 31 December 2005 to 14,3% at 30 September COUNCIL FOR MEDICAL Quarterly Report Quarter 3 5

6 Non-health expenses (continued) At 30 September 2006, the industry averages of the various components of gross non-health expenses expressed as a percentage of total gross non-health expenses were as follows: Sep 06 Dec 05 - Gross Administration Expenses 71,2% 69,4% - Managed Care: Management services 15,9% 16,0% - Acquisition costs (Including distribution costs and broker fees) 12,2% 12,0% - Nett Impairment Losses:Trade and Other Receivables 0,7% 2,6% Operating results Registered medical schemes incurred a total deficit from operations (before taking investment and other income into account) of R2,0 billion compared to a budgeted deficit of R847,3 million at 30 September The total deficit from operations exceeded the budget by 142,6%. Open schemes incurred a total deficit from operations (before taking investment and other income into account) of R1,2 billion compared to a budgeted deficit of R238,5 million whereas restricted schemes incurred a total deficit from operations (before taking investment and other income into account) of R839,1 million compared to a budgeted deficit of R608,8 million. The inclusion of investment and other income resulted in all registered schemes incurring a nett deficit of R8,2 million at 30 September 2006 compared to a budgeted nett surplus of R490,8 million, which represents an actual to budget variance of 101,7%. Investments The current assets to current liabilities ratio for open schemes at 30 September 2006 is 2,1 (2005: 2,1), whereas for restricted schemes it is 3,3 (2005:3,5). The total assets to total liabilities ratio for open and restricted schemes is 2,8 (2005: 2,8) and 4,5 (2005:4,6) respectively. The medical scheme s ability to pay claims from cash and cash equivalents deteriorated from 20,5 days in 2005 to 30,5 days in September This ratio was calculated based on annualised gross claims. COUNCIL FOR MEDICAL Quarterly Report Quarter 3 6

7 REGULATION 29 MINIMUM ACCUMULATED FUNDS Annexure A (SOLVENCY RATIO) INDUSTRY AVERAGE: % Change % Change % Change Quarter 3 (Actual) 2006 Quarter 3 (Budget) % Change Actual 05 vs. Actual 06 % Change Actual 06 vs. Budget 06 Open schemes 15,1% 20,9% 38,8% 28,5% 36,4% 29,6% 3,9% 26,8% 27,3% -9,5% 1,8% Restricted schemes 41,3% 49,6% 20,2% 58,8% 18,6% 63,5% 8,0% 61,5% 58,3% -3,2% 5,5% All registered schemes 22,9% 29,3% 28,2% 37,3% 27,3% 39,1% 4,8% 36,3% 35,4% -7,2% 2,5% COUNCIL FOR MEDICAL Quarterly Report Quarter 3 7

8 SOLVENCY RATIO Annexure B Percentage 70% 60% 58.8% 63.5% 58.3% 61.5% 50% 49.6% 40% 41.3% 37.3% 39.1% 36.3% 30% 20% 10% 22.9% 15.1% 29.3% 20.9% 28.5% 29.6% 26.8% 0% 27.3% (Q3) % Open Schemes - Budget (Q3-2006) All Registered Schemes - Budget (Q3-2006) Restricted Schemes -Actual Restricted Schemes -Budget (Q3-2006) Open Schemes - Actual All Registered Schemes - Actual COUNCIL FOR MEDICAL Quarterly Report Quarter 3 8

9 PRESCRIBED SOLVENCY LEVELS AND NUMBER Annexure C OF BENEFICIARIES Number of schemes 90 Thousand beneficiaries Below Prescribed Level Above Prescribed Level Below Prescribed Level Above Prescribed Level OPEN RESTRICTED Number of Medical schemes - December (2005) Number of Medical schemes - Quarter 3 (2006) Beneficiaries - December (2005) Beneficiaries - Quarter 3 (2006) COUNCIL FOR MEDICAL Quarterly Report Quarter 3 9

10 NETT ASSETS PER REGULATION 29 Annexure D Rand million PB (Q3) Open Schemes (R) Restricted Schemes (R) All Registered Schemes (R) Open Schemes (PB) Restricted Schemes (PB) All Registered Schemes (PB) * Please note that the 2002 and 2003 amounts have not been restated COUNCIL FOR MEDICAL Quarterly Report Quarter 3 10

11 INCOME STATEMENT DETAILS Annexure E for the period ended 30 September 2006 OPEN RESTRICTED TOTAL REGISTERED Average Members Average Beneficiaries Average Age Pensioner Ratio (65+ years) Years % 31,5 32,3 31,7 5,9 7,5 6,4 No. of Dependants per member 1,42 1,35 1,40 Gross Contributions (RISK +PMSA) R' Gross Claims (GROSS +PMSA) (Note a) Gross Administration expenses (RISK +PMSA) Total fees paid to third party administrators (Included in Gross Administration) (Note b) Managed Care: Management services Acquisition Costs (Note c) Broker fees (Included in Acquisition Costs) COUNCIL FOR MEDICAL Quarterly Report Quarter 3 11

12 INCOME STATEMENT DETAILS Annexure E for the period ended 30 September 2006 Nett Impairment losses: Trade and Other Receivables R'000 OPEN RESTRICTED TOTAL REGISTERED Surplus/(Deficit) from Operations ( ) ( ) ( ) Nett Surplus/ (Deficit) for the period ( ) (8 271) NOTES: a) Including Managed care: Healthcare benefits included in Risk Transfer Arrangements and Nett Reinsurance. The reason for Nett Reinsurance being included is due to the fact that the data was not collected separately, and hence could not be split out. b) Including Direct Administration fees, Co-administration fees and Indirect Expenses paid. c) Including Broker Fees and Distribution Costs. * PMSA = Personal Medical Savings Account COUNCIL FOR MEDICAL Quarterly Report Quarter 3 12

13 BALANCE SHEET DETAILS Annexure F at 30 September 2006 OPEN RESTRICTED TOTAL REGISTERED Members at 30/09/ Dependants at 30/09/ Beneficiaries at 30/09/ Non-current Assets R' Current Assets R' Trade & Other Receivables R' Trade & Other Receivables Days Outstanding 18,3 12,4 16,7 Cash & Cash Equivalents R' Total Assets R' Members' Funds (Nett assets per Balance Sheet) R' Accumulated Funsds R' Non-current Liabilities R' COUNCIL FOR MEDICAL Quarterly Report Quarter 3 13

14 BALANCE SHEET DETAILS Annexure F at 30 September 2006 OPEN RESTRICTED TOTAL REGISTERED Current Liabilities R' Trade & Other Payables R' Trade & Other Payables Days Outstanding 19,9 24,1 21,2 Savings Liability R' Outstanding Claims Provision R' Prior Year Claims Outstanding Claims Provision Provision Utilised % 117,1 83,4 105,2 Total liabilities R' Total Assets: Total Liabilities 2,8 4,5 3,4 Current Assets: Current Liabilities 2,1 3,3 2,4 Gross Claims Incurred: Cash and Cash Equivalents Coverage Months 39,5 19,6 30,5 Nett Assets Per Regulation 29 R' COUNCIL FOR MEDICAL Quarterly Report Quarter 3 14

15 BALANCE SHEET DETAILS Annexure F at 30 September 2006 OPEN RESTRICTED TOTAL REGISTERED Solvency Ratio % 26,8 61,5 36,3 NOTES: * In respect of Trade and Other Receivable outstanding days, the denominator is annualised gross contributions * In respect of Trade and Other Accounts payable outstanding days, the denominator is annualised nett claims incurred * In respect of Prior year claims provision utilised = prior year payments / provision at the beginning of the year * In respect of Gross claims cash coverage = cash and cash equivalents / annualised gross claims incurred * We do not express an opinion on the accuracy of the split between current and non-current assets, and current and non-current liabilities COUNCIL FOR MEDICAL Quarterly Report Quarter 3 15

16 NUMBER OF BENEFICIARIES Annexure G Beneficiaries (Thousands) (Q3) Open schemes Restricted schemes COUNCIL FOR MEDICAL Quarterly Report Quarter 3 16

17 DETAILED FINANCIAL INFORMATION: Annexure H ACTUAL VS. BUDGET for the period ended 30 September 2006 OPEN RESTRICTED TOTAL REGISTERED Actual Budget % Variance Actual Budget % Variance Actual Budget % Variance Members (Average) ,3% ,2% ,5% Beneficiaries (Average) ,0% ,9% ,8% Gross Contribution R'000 Income (GCI) ,2% ,1% ,3% Risk Contribution Income (RCI) ,4% ,1% ,5% Gross Claims Incurred (incl. PMSA & Managed Care Claims) (Note a) NA NA NA NA NA NA Nett Claims Incurred (incl. Managed Care Claims) (Note a) ,5% ,2% ,0% Gross (incl. PMSA)/Nett Nonhealth Expenses (Note b) ,4% ,9% ,1% Surplus/(Deficit) from Operations ( ) ( ) 410,0% ( ) ( ) 37,8% ( ) ( ) 142,6% COUNCIL FOR MEDICAL Quarterly Report Quarter 3 17

18 DETAILED FINANCIAL INFORMATION: Annexure H ACTUAL VS. BUDGET for the period ended 30 September 2006 OPEN RESTRICTED TOTAL REGISTERED Actual Budget % Variance Actual Budget % Variance Actual Budget % Variance Nett Surplus/(Deficit) R 000 ( ) ,1% (53 930) 378,9% (8 271) ,7% Quarter End Reserve Position (per Regulation 29) (Note c) ,6% ,3% ,4% NOTES: a) Including Managed care: Healthcare benefits included in Risk Transfer Arrangements and Nett Reinsurance. The reason for Nett Reinsurance being included is due to the fact that the data was not collected separately, and the existence of the inability to split out the data. b) Gross Non-Health Expenses = Administration Expenses (excluding administration expenses recovered from savings plan accounts), Managed Care: Management Services, Acquisition Costs (including Broker Fees and Distribution Fees) and Nett Impairment Losses. Gross and Nett Non-Health Expenses are the same as not one of the schemes have disclosed any administration expenses recovered from savings plan accounts. c) The budgeted amount was calculated by using the budgeted Accumulated Funds per balance sheet as basis, and by adjusting for the following actual amounts as at 30 September 2006: cumulative nett gains on disposal of investments and property plant and equipment included in the income statement, specific assets encumbered for third party liabilities and sub-ordinated loans as approved by the Council. * PMSA = Personal Medical Savings Account * GCI = Gross Contribution Income * RCI = Risk Contribution Income * NA = Information not available We do not express an opinion on the accuracy of the budgeted figures submitted. COUNCIL FOR MEDICAL Quarterly Report Quarter 3 18

19 TOTAL NON-HEALTH EXPENDITURE Annexure I Rand Million Gross administration Expenditure Managed Care: Management Services Broker Fees Impaired Receivables Total Non-Health Expenditure Year to date - 30 September 2006 (actual) Year to date - 30 September 2006 (budget) COUNCIL FOR MEDICAL Quarterly Report Quarter 3 19

20 DETAILED FINANCIAL INFORMATION Annexure J ACTUAL VS. BUDGET for the period ended 30 September 2006 OPEN RESTRICTED TOTAL REGISTERED Gross Contribution Income (GCI) PABPM (Actual-R) 696,3 670,0 689,0 PABPM (Budget-R) 718,9 716,8 718,4 % Variance (PABPM actual vs. budget) -3,1% -6,5% -4,1% Risk Contribution Income (RCI) PABPM (Actual-R) 613,0 619,1 614,7 PABPM (Budget-R) 634,5 662,6 642,0 % Variance (PABPM actual vs. budget) -3,4% -6,6% -4,3% Gross Claims Incurred (incl. PMSA & Managed Care Claims) (Note a) As % of GCI (Actual) 89,2% 97,2% 91,4% As % of GCI (Budget) NA NA NA PABPM (Actual-R) 621,0 651,3 629,5 PABPM (Budget-R) NA NA NA % Variance (PABPM actual vs. budget) NA NA NA COUNCIL FOR MEDICAL Quarterly Report Quarter 3 20

21 DETAILED FINANCIAL INFORMATION Annexure J ACTUAL VS. BUDGET for the period ended 30 September 2006 OPEN RESTRICTED TOTAL REGISTERED Nett Claims Incurred (incl. Managed Care Claims) (Note a) As % of RCI (Actual) 86,2% 97,3 % 89,3% As % of RCI (Budget) 82,8% 95,1% 86,2% PABPM (Actual-R) 528,2 602,4 549,0 PABPM (Budget-R) 525,3 630,1 553,2 % Variance (PABPM actual vs. budget) 0,6% -5,3% -0,8% Gross/Nett Non-health Expenses (Note b) As % of GCI (Actual) 16,1% 9,7% 14,3% As % of GCI (Budget) 15,9% 9,7% 14,3% As % of RCI (Actual) 18,2% 10,4% 16,0% As % of RCI (Budget) 18,0% 10,5% 16,0% PABPM (Actual-R) 111,8 64,7 98,6 PABPM (Budget-R) 114,5 69,8 102,6 % Variance (PABPM actual vs. budget) -2,3% -7,4% -3,9% Surplus/(Deficit) from Operations As % of GCI (Actual) -3,9% -7,2% -4,8% As % of GCI (Budget) -0,7% -5,2% -1,9% PABPM (Actual-R) (27,1) (48,0) (32,9) PABPM (Budget-R) (5,3) (37,2) (13,8) % Variance (PABPM actual vs. budget) 410,2% 28,9% 138,3% COUNCIL FOR MEDICAL Quarterly Report Quarter 3 21

22 DETAILED FINANCIAL INFORMATION Annexure J ACTUAL VS. BUDGET for the period ended 30 September 2006 OPEN RESTRICTED TOTAL REGISTERED Nett Surplus/(Deficit) As % of GCI (Actual) -0,5% 1,3% 0,0% As % of GCI (Budget) 1,7% -0,5% 1,1% PABPM (Actual-R) (3,5) 8,6 (0,1) PABPM (Budget-R) 12,1 (3,3) 8,0 % Variance (PABPM actual vs. budget) -70,0% 360,9% -101,7% Quarter End Reserve Position (per Regulation 29) (Note c) PB (Actual-R) 2 207, , ,1 PB (Budget-R) 2 366, , ,0 % Variance (PB actual vs. budget) -6,7% -2,1% -3,5% Solvency Ratio 2006 % (Actual) 26,8% 61,5% 36,3% 2006 % (Budget) 27,3% 58,3% 35,4% COUNCIL FOR MEDICAL Quarterly Report Quarter 3 22

23 DETAILED FINANCIAL INFORMATION Annexure J ACTUAL VS. BUDGET for the period ended 30 September 2006 NOTES: a) Including Managed care: Healthcare benefits included in Risk Transfer Arrangements and Nett Reinsurance. The reason for Nett Reinsurance being included is due to the fact that the data was not collected separately, and the existence of the inability to split out the data. b) Gross Non-Health Expenses = Administration Expenses (excluding administration expenses recovered from savings plan accounts), Managed Care: Management Services, Acquisition Costs (including Broker Fees and Distribution Fees) and Nett Impairment Losses. Gross and Nett Non-Health Expenses are the same as not one of the schemes have disclosed any administration expenses recovered from savings plan accounts. c) The budgeted amount was calculated by using the budgeted Accumulated Funds per balance sheet as basis, and by adjusting for the following actual amounts as at 30 September 2006: cumulative nett gains on disposal of investments and property plant and equipment included in the income statement, specific assets encumbered for third party liabilities and sub-ordinated loans as approved by the Council. * PMSA = Personal Medical Savings Account * GCI = Gross Contribution Income * RCI = Risk Contribution Income * PABPM = Per Average Beneficiary per month * PB = Per Beneficiary at end of period * NA = Information not available We do not express an opinion on the accuracy of the budgeted figures submitted. COUNCIL FOR MEDICAL Quarterly Report Quarter 3 23

24 RISK CLAIMS RATIO: RISKS BENEFITS GRAPH Annexure K Rand PABPM 700 Claims ratio 90% % 90% 89% % 88% % % 87% 87% 86% % 85% 0 Year to date - 30 September 2006 (actual) Year to date - 30 September 2006 (budget) Risk Contributions PABPM Risk Benefits Incurred PABPM Claims Ratio 85% *PABPM = Per Average Beneficiary per month COUNCIL FOR MEDICAL Quarterly Report Quarter 3 24