Don’t just drop medical aid

NEEDS: DON’T CHANGE DUE TO LOW PREMIUMS

Here are a few tips when comparing healthcare options: Never change to another medical scheme or benefit option because the contribution’s lower than your current option. Compare the actual benefits, exclusions, value adds and service delivery, with your specific healthcare needs, such as chronic conditions and medication.

100% cover does not mean you’re fully covered. Specialists and in-hospital charges can be up to 400% of the benefits offered by medical scheme. So if your medical scheme only pays out at 100% of tariff, you’re liable for the shortfall or remaining 300%. This can amount to thousands.

Gap cover policies for medical scheme shortfalls are proving to be invaluable safety nets by covering certain in-hospital and specialist shortfalls that may occur.

Many consumers are opting for more affordable hospital cover plans only, then topping up cover with gap insurance to address any shortfalls. But they then also take on the risk of having to fund day-today expenses for general practitioner visits, dentistry and optometry. An analysis of your claims history will be important in assessing whether such an option will work for you.

Out of hospital or day-to-day limits vary dramatically between medical schemes and benefit options. If your medical savings limits are low, but you have regular visits to the doctor for certain conditions, you could find that two or three consultations with a specialist will quickly deplete your funds, leaving you to fund any further costs from your pocket – or at least until your self-payment gap, if applicable, has been reached.

Certain medical schemes limit hospital pay-outs per family per year. If more than one family member requires hospitalisation in the same year, you could face considerable financial stress.

Exclusions and waiting periods may apply.

Many benefit options require you to use practitioners and hospitals designated by the medical scheme, as they provide medical services at a fixed rate.

Gavin Griffin is with Aon Employee Benefits