A lot to think about when shopping for medical aid cover
Consider day-to-day expenditure when choosing a plan
Shopping around for a medical aid is not easy considering you have 20 open market medical aid schemes to choose from.
The costs of medical aid are also not relenting, and with the implementation of the proposed government’s National Health Insurance nowhere in sight, South Africans will continue having to make important decisions and choices about medical aid cover to access quality healthcare.
Private health care costs between 2000 and 2017 doubled in real terms, according to Martin Rimmer, the CEO of Sirago Underwriting Managers. Rimmer says the cost trends indicate that by 2028, the private healthcare costs will have doubled again.
“There are many complex reasons for this upward trajectory. Key is the fact that unlike the pharmaceutical industry, there is no pricing regulation on healthcare provider tariffs.
“With South Africa facing a dire shortage of healthcare professionals, specialists can charge any rate, often more than 300% to 500% higher than the rate paid by medical schemes,”
according to Rimmer.
“Most notable is that while medical scheme contributions increase every year in a bid to keep pace with healthcare hyperinflation, the benefits are decreasing.
“This means that many medical scheme members are paying more for the same or less medical scheme benefits.”
Rimmer advises consumers to look out for the following when considering changing medical scheme benefit option:
• What is your current dayto-day expenditure on healthcare and do your existing benefits provided sufficient cover or were you left out of pocket?
• Are you or any dependants registered for a chronic condition, and does it qualify under the 27 regulated chronic conditions or as an additional disease listing for cover?
Consider whether the premium saving on a lower benefit option is worth the cost of the additional chronic medicine which you may have to self-fund on a lower benefit option.
• When you pay less, understand that you normally receive less cover and benefits. Be comfortable with the level of risk you can afford to take on as out-of-pocket costs.
• Get gap cover to shield you from big shortfalls on in-hospital treatment, from the anaesthetist to the specialist surgeon.
A broker will be adept at taking your through the various gap options that are suited to your needs, and that would best match your chosen medical scheme option.
• Benefit options that pay for prescribed minimum benefits (PMBS) only (PMBS are conditions that medical schemes must pay for, at cost, according to regulations) will have an impact on your pocket as you will need to pay for any non-pmbs.
A plan that covers hospitalisation only means that all dayto-day primary care, such as GP visits, dentistry, optometry, radiography, and medication will need to be covered from your pocket.
• If you are considering a move to a lower benefit option, do so within the same medical scheme. You’ll avoid any waiting periods.