Affordability is key when it comes to healthcare

FINDING the right healthcare cover that is affordable and meets your healthcare needs is increasingly important.

Medical aid members are currently reviewing their options to ensure they make the right decisions for the year ahead regarding access to the highest quality of healthcare. It’s a balancing act that needs to support one’s physical, mental and financial well-being.

According to Lee Callakoppen, principal officer of Bonitas Medical Fund, there are 17 open medical schemes in South Africa, with each offering a range of plans and benefits.

“Making the right choice can be overwhelming, which is why we advocate consulting a medical aid broker or financial advisor.”

Brokers accredited by the Council of Medical Schemes are qualified to offer free advice. They also know the financial stability of each scheme, which should be a consideration in the final decision.

A good starting point is to compare what is available.

Networks - a new trend

The rule of thumb is that contributions should not exceed 10% of your monthly income. One way of reducing contributions without compromising on care, is to use a network plan. Generally, these are about 15% cheaper, but you have to use network hospitals. These are hospitals with which a scheme has negotiated discounted and set costs for its members.

“Members are seeing the value of hospital networks. Around 1.2 million open scheme members are on a network option. We have restructured our options and, from next year, 85% of our members will be within a 30km radius of a network hospital.”

Virtual has the Edge

Bonitas Edge plans – BonStart and BonStart Plus – are among the most innovative in the country. Driven by technology and easy access through virtual integration and digital intervention, they appeal to new and young medical scheme entrants.

There is no contribution increase on BonStart for 2023, which means a main member’s contribution is R1 338 per month. BonStart Plus increases by 2% or R33 per month (R1 703) for a main member. “In fact, nine of our 15 plans are priced under R3 000.”

Designated service providers

Healthcare costs in South Africa are unregulated, which means providers are free to charge any tariff.

“To help members avoid out of pocket expenses and get more value, we implement networks to negotiate better tariffs.”

This includes more than 4 000 GP practices, a pharmacy network (around 2 500) to dispense medication through Scriptpharm, DENIS for dental care (around 3 000 practices), and an optical network of more than 2 300 practices through PPN.

Your health status

Reflect on your health status by taking into consideration pre-existing conditions and ailments, together with chronic medication or treatment you or your family use.

Look at how often you visit a doctor or specialist, and what you spend on dentistry or optometry. This will help you decide whether you need a comprehensive medical aid or a hospital plan.

Fine print

Benefits vary from plan to plan. Read the fine print to understand what is and isn’t covered. Check what supplementary benefits are included that can potentially save significant day-to-day expenses. Are there preventative care benefits such as basic screenings for blood pressure, cholesterol, blood sugar and BMI measurements, mammograms, pap smears and prostate testing? Do these extend to maternity programmes, dental check-ups, flu vaccinations and more?

Also look at what managed care programmes are available. These help members manage severe chronic conditions such as cancer, diabetes and HIV/Aids.

Age impacts your decision

Different life stages determine your needs. If you have young children, are there sufficient child illness benefits? For young couples looking to start a family, check if your option has sufficient maternity benefits. If you’re slightly older, perhaps select an option that covers chronic conditions and provides sufficient in-hospital cover.

“When it comes to healthcare, take time to research and understand your needs. Then find a plan that offers you the cover you need that is within your budget and gives you peace of mind.”