Weekend Argus (Saturday Edition) - - FRONT PAGE -

ONE find­ing of the sur­vey was that many con­sumers were un­sure of their own med­i­cal scheme de­tails and their en­ti­tled ben­e­fits. “We have found that many con­sumers tend to be largely ig­no­rant about which med­i­cal scheme op­tion they are on and what ben­e­fits this en­ti­tles them to,” Jill Larkan says.

She points out that you can po­ten­tially save sig­nif­i­cantly if you do an hon­est and thor­ough anal­y­sis of your real med­i­cal needs. Your monthly med­i­cal scheme con­tri­bu­tion in­cludes a fee for pro­fes­sional guid­ance and ad­vice, some­thing of which many peo­ple are un­aware, and Larkan says the as­sis­tance of a pro­fes­sional health­care con­sul­tant should never be un­der­es­ti­mated.

“One ex­am­ple of sav­ing is to use a med­i­cal scheme’s network op­tion. Peo­ple liv­ing in an area where there is a com­pre­hen­sive network of pre­ferred med­i­cal prac­ti­tion­ers and hos­pi­tals can down­grade and get the same ben­e­fits for a lower price.

“Too many con­sumers stay on the same plan for years, re­gard­less of how their cir­cum­stances or plan’s ben­e­fits change. This means peo­ple tend to pay for ben­e­fits they don’t need, or they are un­aware of ben­e­fits that are no longer pro­vided,” Larkan says.

She says you can start your se­lec­tion process by con­sid­er­ing three ba­sic fac­tors:

• Level of in-hospi­tal cover. This de­pends largely on the level of risk you want to carry if you have to be hos­pi­talised in the next 12 months. Hospi­tal fees are typ­i­cally cov­ered in full, but spe­cial­ist fees are cov­ered at dif­fer­ent lev­els, which could be from 100% to 300% of the scheme’s set rates. You may con­sider gap cover, a short-term insurance prod­uct de­signed to cover the short­fall.

• Network op­tions. “This de­pends on whether you ac­cept a dis­counted premium rate in ex­change for hav­ing ac­cess to a lim­ited network of hos­pi­tals and service providers,” Larkan says.

• Out-of-hospi­tal charges. Here you need to con­sider to what ex­tent you are will­ing to pay for non-hospi­tal ex­penses out of your own pocket.

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