WHAT DIFFERENT BENEFIT OPTIONS OFFER

services, such as ambulances. No day-to-day expenses, except the prescribed minimum benefits (PMBs) – particularly the chronic conditions – are covered. Do not confuse a medical scheme hospital plan with an insurance product that offers limited hospital cover for specified events.

• New-generation options with medical savings accounts, which provide benefits for day-to-day healthcare services, such as visits to a general practitioner and the medication prescribed, optometry and dentistry. These options offer certain insured benefits – usually those covering hospital and major medical expenses – and members self-fund other benefits by contributing to a medical savings account. These options usually allow members to spend their savings contributions as they want on any medical expenses, but the rules of certain schemes may limit payments from these accounts to, for example, scheme rates.

If you choose an option with a savings account, you can access the full amount at the beginning of the year, although you contribute to the account monthly over the year. If you do not spend your savings account contributions in a particular year, the balance in your account carries over to the next year. Contributions to a savings account cannot exceed 25 percent of your total contribution.

However, the savings are often inadequate and run out during the year, leaving you to foot the bill for your day-to-day healthcare needs. To counter this, you should analyse your needs and check whether the savings account will meet them. If not, you need to set aside an additional amount each month for these costs.

Certain schemes offer abovethreshold benefits to members on options with medical savings accounts. These benefits can be accessed once you have spent a specified amount on certain claims and exhausted your day-to-day cover or the funds in your medical savings account. Usually, only what the scheme regards as essential claims count towards this threshold, and there may be rules about what counts and what does not.

• Network options. Some options, typically lower-cost ones, restrict members to using certain hospitals and doctors, pharmacies, optometrists and dentists that operate within a network. Some options may have a network for only some providers, or only for PMBs, or make use of a network of “preferred providers” that you must use if you want to ensure the scheme pays the costs in full.