How to choose the right medical aid for you
BY JININE BOTHA
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.
IT IS IMPORTANT TO KNOW HOW TO MANAGE YOUR MEDICAL AID EFFECTIVELY, OR YOU MIGHT RUN OUT OF BENEFITS BY MARCH.