Get the right medical cover
DON’T GO IN BLIND: IT IS AN EXPENSIVE GRUDGE PURCHASE, SO DO YOUR HOMEWORK
How to choose a medical aid scheme is a question many struggle with.
It is expensive to be a member of a medical aid scheme and is therefore a grudge purchase, especially if consumers and their families never get sick. They only realise the value when someone does get sick, like many did during the pandemic, or when a family member is hurt in an accident.
Choosing a medical aid scheme is not something you do offhand, and you have to approach this important decision carefully to ensure you make the right decision.
You have to ensure that you can afford the membership and that you get the cover you require, so keep the following tips in mind.
Check your budget
See how much you can afford each month.
What do you require from your medical aid scheme?
Answer these questions:
Are you single or do you have a family?
How old are you and your spouse?
Do you have children and what are their ages?
Are there any hereditary diseases
in your families?
Do any of you suffer from a chronic disease which requires continuous treatment?
Does your child get sick every winter?
Ask people you know about their medical cover and an expert
Once you have asked your doctor and friends and decided on a medical aid scheme, make an appointment with a broker to help you choose the right one for your needs.
Check the scheme’s reserves
Medical aid schemes must, according to law, have at least 25% of its members “contributions” in reserve and must invest them to ensure funds are available to pay out claims.
What does the scheme offer?
Consider the day-to-day limits and how much your medical savings account will be per year. Your benefits could be depleted by April if the savings account only provides a small amount.
Look at how much you will
have to pay out of your own pocket compared to what the medical aid will cover. Consider the size of the hospital benefit. See if you will be limited to specific hospitals and if so, if one of these hospitals is close to you. Choose a fund that provides 200% of the fund rate for hospital treatment.
Medical cover for a family of four of R600 000 per year will not be worth much, as many saw during Covid when whole families had to be admitted to hospital.
Cancer treatment is also an important factor. How is the treatment determined and will the scheme pay for a new treatment?
Exclusions
There are usually two exclusions: for less than a year when you are a new member and those that last forever. Ensure you are satisfied with them before joining.
Will a hospital plan not be be er?
A hospital plan only pays when you are admitted to hospital, depending on certain conditions.
It only pays out to provide for loss of income and not for direct medical expenses. Direct medical expenses can be much more than the amount the plan pays.
Medical aid scheme or medical insurance?
Your medical aid pays for conditions up to scheme tariffs, but health insurance will pay out a fixed amount if something specific happens to you, not specific amounts for specific services.
It provides for loss of income and contingency expenses but not direct medical expenses. The medical expenses may also far exceed these contingency expenses.
Medical aids and medical insurance providers are controlled and governed by legislation and statutory regulation bodies.
According to the Medical Schemes Act, certain conditions and emergencies, called Prescribed Minimum Benefits, must be covered in full by the medical scheme regardless of the plan; medical insurance does not have this requirement.