GOOD HEALTHCARE A CONCERN, MEDICAL AIDS A CHALLENGING CHOICE
Access to good healthcare remains a concern for most South Africans and choosing a medical aid to suit one’s financial status and needs, is challenging, says Gerhard van Emmenis, Principal Officer Bonitas Medical Fund.
He advises, ‘Whether joining for the first time, switching schemes or adjusting options, it’s important to make careful comparisons. Find a scheme and options that not only works for you and your family’s needs but is also within your budget.”
Take time to read the information to ensure you understand what is being offered and can make a comparison from a point of knowledge. Look at what your typical healthcare costs were over the past 12 months and how much you spent on every day healthcare expenses like visits to doctors and over the counter medicines.
Were you or any of your dependants admitted to hospital? Did you need to visit a specialist? Do you and your dependants have any chronic conditions? How much do you spend on dentistry or optometry?
Then consider which expenses were once-off , such as childbirth, or are likely to come up repeatedly, such as flu.
If you are on an existing medical aid plan, check whether you exhausted your day-to-day benefits and/or savings, the extent of your co-payments and how much you paid out-of-pocket.
Van Emmenis reminds that benefits vary from plan to plan so check what is covered and whether there are supplementary benefits which can potentially save significant day-to-day expenses. These may include anything from wellness screenings to maternity benefits, flu vaccinations, mammograms, pap smears and HIV tests. All costly, if you have to pay for them yourself.
Often the cost containment measures for the day-to-day benefits are broad. Bear in mind, the following:
Does the medical aid contract with doctors and specialists and are you willing to use them? Doing so usually means you are covered in full and can avoid co-payments. Moreover, you will be charged your medical aid rate.
Are additional GP consultations offered after you have exhausted your day-to-day benefits?
He says, “One of the most misunderstood elements of medical plans is how medical aid savings work i.e. the fixed amount a medical scheme gives you at the beginning of the year. You can use them for daily out-of-hospital medical expenses, such as GP and specialist consultations and over the counter medicine but it is imperative to use the savings wisely to get maximum value for money.”
Day-to-day benefits for traditional medical aid options, provide a fixed benefit for various out-of-hospital expenses, such as GP consultations and dentistry. This is paid from risk. Age matters If you have young children, ensure that the medical aid option you select provides sufficient child illness benefits. For young couples looking to start a family, check that your option covers maternity benefits. If you are slightly older, ensure the option you select covers chronic conditions, offers managed care programmes and sufficient in-hospital cover in the event of hospitalisation.
Affordability Consider all the costs before making your final decision. For example, monthly contributions should not exceed 10 percent of your monthly income. Check the level of co-payment i.e. the fee a member is liable for when making use of certain medical services. The medical aid does not cover 100 percent of the costs and the member has to pay for a percentage of the medical service.
Co-payments usually apply to specialist or elective medical procedures but this will differ among schemes - good reason for thorough research. Ideally there would be no co-payments or only a few. Waiting periods, penalties The strict rules and regulations governing the medical aid industry are to protect members and the financial sustainability of medical schemes. So, schemes may
impose a three-month general waiting period or condition-specific of up to 12 months.
These will generally apply if you or your dependants were not on a medical aid for at least 90 days before joining or if you have never been a member of a medical aid.
Also, in some instances, if you chose to move from one medical aid to another.
In South Africa, schemes can impose late-joiner penalties on those who join after the age of 35 and have never been medical aid members.
This is in fairness to long term members.
It can also apply if you have not belonged to a medical aid for a specified period since April 2001.
Van Emmenis adds, ‘Your health is important, and it makes sense to do serious homework.”