Be Prepared for the Ailments Associated with Each Life Stage
October 6, 2016
Does your medical scheme benefit option match the ailments and needs of your age group?
Some health conditions can strike out of the blue. But other health problems tend to arise as a result of ‘wear and tear’.
And the presence of such conditions has a distinct correlation with age.
Therefore, you should factor in age when making a decision on which medical scheme benefit option will best meet your needs.
That applies particularly to such predictable risks, in the foreseeable future.
“There are so many health events that we cannot predict, but certain conditions are more prevalent in particular age groups. For example, data from Resolution membership indicates that the average age for claims on orthopaedic surgery on hips, knees and spinal procedures is 51 to 52 years old,” explains principal officer of Resolution Health Medical Scheme, Mark Arnold.
“It is relatively common for people in their 50s to require such orthopaedic procedures. Similarly, the average age for cardiovascular surgery is 63. Some people may never expect these types of operations. And in some exceptional cases, the need may arise at a younger age. In the main, however, it is pragmatic to align your healthcare cover to the everyday healthcare needs associated with your age group.”
Arnold says it is also worthwhile considering the hereditary health ailments members of your biological family have experienced. These can also provide some indication of the kind of health events that might affect you. “Say for example you know that your great-grandfather, grandfather, and father all experienced shoulder problems in later life. It would, therefore, make logical sense to ensure that your benefit option will cover rotator cuff surgery with the surgeon and at the healthcare facility of your choice,” he notes.
“Some medical schemes have agreements with various healthcare provider networks. These agreements require that members, or members on a particular benefit option, have planned procedures in a network hospital.
“People often overlook this when choosing their benefit option. But when faced with the need for surgery, they want to go to the doctor and hospital of their choice. If these are not within the preferred provider network, however, the member faces a hefty co-payment.”
Check Ailments Cover Each Year
Once a year, members have the opportunity to review their level of healthcare cover for the next year. They must decide whether to remain on their existing benefit option or change to a different one.
“At this time, medical scheme members should consider their present state of health. And also the types of age-related and hereditary conditions that may present themselves,” Arnold advises.
“While many people look for ways of economising as they approach retirement, we encourage members to think carefully before compromising on their healthcare cover.
One does not necessarily see the advantages of a healthy benefit option on a daily basis. But it certainly provides peace of mind to know that you have access to comprehensive cover when you need it.
As people age, their health care needs tend to grow. It is advisable to increase, or maintain, your level of health care cover as you get older.”
Medical Aids are Not for Profit
By law, medical schemes must operate as not-for-profit entities. They must act in the best interests of their members. Also, they must provide comprehensive cover for 271 of the most widespread and severe medical conditions through prescribed minimum benefits (PMBs).
“The central risk pool of a medical scheme funds PMB payments. Therefore they are available on all benefit options. But remember that the degree of cover provided may differ considerably if the member does not seek treatment through a preferred healthcare provider. That is if this is a stipulation of your benefit option,” Arnold adds.
“PMBs act as a safety net, rather than a cheap healthcare cover solution. Included in the PMB list are emergency and chronic conditions. But thousands of other health conditions can compromise an individual’s quality of life – particularly later in life.
“When choosing your benefit option for the year ahead, it is imperative that you consider the possibility that you might find yourself, or one of your beneficiaries, in need of expensive treatments for non-PMB conditions. After the benefit option change period ends, you are committed to the level of cover you have chosen for the year and must be confident that it will be sufficient.”
Admittedly some health conditions occur without warning or any means of prevention. But Resolution Health encourages members to take proactive care of their health. Do this through regular health screenings, such as Pap smears, prostate checks, and blood pressure testing to name a few.
Resolution Health’s wellbeing and rewards partner Zurreal, through its Zurreal Platinum programme, incentivises routine health checks and exercise through cash-back rewards, which are paid into members’ Zurreal Healthcards as savings towards health-related expenses.
“Leading a healthy lifestyle can go a long way towards safeguarding your physical wellbeing. but it cannot provide complete protection against some ailments, including some of those associated with ageing, or which may be inherited. Ultimately, we will all require some degree of healthcare and cannot predict when such a need will arise.
“You should budget monthly towards healthcare expenses in the form of medical scheme cover that is as comprehensive as you can afford.
Do this rather than being confronted with steep healthcare bills or co-payments when you are also burdened with health ailments,” Arnold concluded.
All info was correct at time of publishing