How to choose the right med­i­cal aid for you


Finweek English Edition - - COVER -

Flu sea­son has just started i n South Africa. This is usu­ally t he t i me of year when you start ques­tion­ing the value for money you get from your med­i­cal aid.

Ac­cord­ing to re­search con­ducted by Health­bridge, a com­pany ded­i­cated to trans­form­ing the busi­ness side of the health­care sec­tor, the amount that most pa­tients have avail­able in their med­i­cal sav­ings ac­count starts to decline steadily from May to­wards the end of the year, with about 60% of claims not be­ing cov­ered by med­i­cal aids dur­ing De­cem­ber.

This means t hat by De­cem­ber, pa­tients need to pay for more than t wo-t hirds of t heir own med­i­cal ex­penses in cash.

Ac­cord­ing to Naiefa Rashied, a lec­turer in eco­nomics at the Uni­ver­sity of Jo­han­nes­burg ( UJ), choos­ing a med­i­cal aid pack­age that is right for you and your fam­ily is not some­thing that should be done with­out as­sess­ing your needs and in­ves­ti­gat­ing which op­tion would suit those needs.

An in­di­vid­ual’s in­come (or joint in­come if ap­pli­ca­ble), their age, health sta­tus as well as the health and age of the in­di­vid­ual’s de­pen­dents, are some of the f irst fac­tors that should be taken into ac­count, Rashied says.

If you do have the luxury of choice, for ex­am­ple, when your med­i­cal aid is not cho­sen by your em­ployer, the ad­vice of an i nde­pen­dent bro­ker would be help­ful, says Health­bridge’s Ivone Veiga-Moroldo.

“Get adv i ce f rom a r ep­utable in­de­pen­dent bro­ker who rep­re­sents a num­ber of med­i­cal aids. Then have a chat with your doc­tor and get his/her ad­vice. It is also a good idea to speak to your fam­ily and friends re­gard­ing their per­sonal ex­pe­ri­ences with their med­i­cal aids.”

When choos­ing a med­i­cal aid, it is clear that one size does not f it every­body. And be­cause a med­i­cal scheme can eas­ily eat 10% to 20% of your monthly in­come, both Rashied and Veiga-Moroldo ad­vises that you com­pletely un­der­stand the plan you choose.

“There a r e v a r i ous s t e ps t o man­age your med­i­cal aid in the most eco­nom­i­cally ef­fec­tive man­ner, but a good rule of thumb is to choose a med­i­cal aid based on your needs. If you use a GP very of­ten, then per­haps a hos­pi­tal plan would be more value for money, if the hos­pi­tal plan al­lows un­lim­ited GP vis­its.”

It is also im­por­tant to check the scheme’s pay­ment record and it s sol­vency ra­tio.

“Your GP’s sec­re­tary should be able to tell you if they ex­pe­ri­ence prob­lems with a spe­cific scheme’s pay­outs. An in­de­pen­dent bro­ker is also valu­able in this re­gard. The bro­ker should be able to tell you a scheme’s pay­ment record and if they are in f inan­cial trou­ble or not.”

Once you have made a choice based on your health, age and bud­get, it is im­por­tant to know how to man­age your med­i­cal aid ef­fec­tively, or you might run out of benefits by March.

Rashied sug­gests that you pur­chase sched­ule 0, 1 and 2 med­i­ca­tions with cash and not your scheme’s med­i­cal sav­ings. “This way you can use your med­i­cal sav­ings for larger bills.”

She a l so ad­vises t hat you pay spe­cial­ists or GP’s con­sul­ta­tion fees and med­i­cal prod­ucts like neb­u­lis­ers in cash.

“It would be good to seek ad­vice from your med­i­cal aid be­fore­hand, but you should be able to claim th­ese fees then from the med­i­cal aid af­ter­wards.”

Bot h e x p e r t s s a y t he most im­por­tant cri­te­rion is re­ally to in­vest in un­der­stand­ing the benefits of your med­i­cal aid plan. “This is the only way you will know what is cov­ered and what you would be li­able for,” says Veiga-Moroldo.


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