Benefits that help out when your savings account is depleted

If you’ve depleted the funds in your medical savings account you may be entitled to certain extra benefits payable by your scheme.

Consultations and treatment for all prescribed minimum-benefit (PMB) conditions must be covered even after your savings are depleted.

The PMBs cover close to 300 conditions, such as meningitis, various cancers, menopausal management, cardiac treatment, mental illnesses such as anorexia and bulimia, and many others, including all medical emergencies and 25 common chronic illnesses.

Make sure the tests and consultations have the right code — some may have to be coded after a diagnosis. Often, tests have what is known as a Z-code because the diagnosis is unknown, and your scheme may not pick up that that test is related to a PMB.

Beyond this, schemes offer some essential benefits to members who have depleted their savings.

Discovery Health members on the Saver options, for example, get a set number of general practitioner consultations with doctors in the scheme’s network of GPs. Members on the Comprehensive, Executive and Priority options get unlimited consultations with such GPs. On some Discovery options, there is cover for two casualty visits for children under 10.

Bonitas provides members who have spent all their savings with childcare benefits for children under 12, such as two GP consultations and up to three paediatric consultations.

Jill Larkan, head of health-care consulting at GTC, says some schemes pay certain benefits directly from your risk benefit for the benefit of members who have exhausted their savings and those who don’t have savings accounts.

Fedhealth, for example, pays for unlimited GP and dentist consultations on all but four of its hospital-only plans, she says. It also gives all its members traumaroom cover for PMB and non-PMB events.

Momentum Health members, excluding those on the Ingwe and Impact options, can get extra benefits by participating in the HealthReturns programme. You get points for doing health tests and exercising, and these are converted to a cash benefit.

Many schemes also offer screening benefits for tests such as pap smears.