My Medical Planning
This section of the site will assist you firstly to ensure you have the right medical plan for yourself and your family and then to implement and manage your medical planning correctly.
Having a medical aid these days is vitally important. However, they can also be very costly.
On that note, we are sure that you will agree, making sure that you are on the correct medical aid and ensuring that you are paying what is most economical for your family needs is also very important.
Which scheme is best for YOU?
Finding the right medical scheme and plan for you and your family can feel like trying to find a needle in a haystack. There are a variety of schemes out there with a variety of plan offerings and all have a purpose and great benefits for different users, BUT, which is a best fit for you and your family.
The challenge here is to be able to evaluate each scheme and all of its options and benefits and be able to compare as best possible “like for like” and then make your choice.
Firstly, what exactly is Medical Aid and how does it work.
South Africa has a dual healthcare system, consisting of public and private providers. Public medical services are provided by the government and generally used by the general population, while Private hospitals and healthcare services are used mostly by members of medical schemes or those able to pay for these services out of their own pocket. Medical aids are regulated by the Medical Schemes Act (1998).
What is the purpose of medical aid?
In laymen’s terms, the purpose of a medical aid is to ensure that you are able to pay for treatment received from either a GP or specialist, or while in hospital.It is very important to “insure” your health. Accidents can happen and you and your family’s health is unpredictable. If you cannot afford comprehensive cover, at least a basic hospital plan is recommended.
So, how do you choose a scheme that best suites you & your family?
Here are 7 checks you can do to ensure that you choose the right scheme for YOU:
- What can you afford to spend on medical premiums each month? Remember, this is a very important aspect of your families planning so be reasonable but be realistic.
- What are your families medical needs?
- Be aware of changes and change your plan accordingly.
Strength of the Scheme
- Make sure that you join a scheme that is financially stable and is not going to have excessive premium increases and is reliable and consistent with regards to claim payments.
Administration & Service
- Check to make sure that the scheme you join has a record for good service and administration. You don’t want to be fighting with your scheme every time you use your medical aid.
Understand your In-Hospital benefits. exclusions and co-payments
- You need to ensure, before you join a scheme, what the cover is that each scheme offers you. More specifically, what percentage cover do they offer based on the “Normal Medical Scheme Rate”? Is it 100% or 150% or up to 300%.
- Are you going to have to make co-payments based on what your services provider charges?
- Also be aware of what exclusions are made on the scheme such as joint replacement and neck and back operations.
Understand your Out-of-Hospital Cover
- These days, most options in the market place work with a “savings plan”. Basically what happens here is that you are able to use this savings allocation immediately, but once this savings amount has been depleted, you will be required to pay for services directly from your pocket. Some options allow for an “above threshold” offering which can be useful if your costs and claims are high. Others have specific networks which are offered which allow the user unlimited doctor and dentist visits based on the plan.
- If you or anyone in your family has a chronic condition, and requires chronic medication, please ensure that the option and scheme you choose covers both the condition as well as the specific medication you require.
Oncology, dialysis and HIV
- It is important to make sure how the scheme and option cover oncology, dialysis and HIV. Most schemes have specific benefit programs for these conditions, which offer good cover, but it is important to make sure exactly what that cover is.
Taking the above into account, What Plan type is best for your Family?
All scheme options are based on 2 plan primary types. These being:
- Traditional Plans: These plans cover almost all medical expenses (subject to the rules of the individual scheme) and include benefits for in-hospital and day-to-day expenses.
- Hospital Plans and Hospital Plans with Savings: These plans cover expenses incurred while in hospital, however you are responsible for your own day to day medical expenses either via your savings pan or directly from your pocket. These plans are generally more cost effective and are widely available.
So, where to from here and how can we help?
The whole idea of the above explanation and this exercise, is to give you some initial food for thought and some questions you can ask yourself about your own medical plan.
If you would like some help and guidance in reviewing your medical plan to check and make sure that you are actually on the correct plan for yourself and your family, please do make contact with us. We will do a full comparison of a number of schemes and plans and then report back to you with a proposal and comparison of best options for you, based on your family's specific needs and requirements.