HOW TO OPTIMISE YOUR BENEFITS

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.