The Good, the Bad and the Ugly of Medical Aids
March 17, 2017
If you’re lucky enough to have medical aid, you will avoid long queues, long waiting periods, as well as understaffed and underfunded government hospitals that often don’t have the necessary equipment to diagnose or treat certain conditions. In this article, we will cover the good the bad and the ugly of medical aids.
As a member on a medical aid, you will have access to quality care without having to worry about how you’re going to pay for it in the event of a medical emergency.
The Good the Bad and the Ugly of Medical Aids
You will also have the cover, albeit not fully, for many conditions should you get one, such as cancer.
But also consider, you get what you pay for.
People are often unaware what they have cover for or not. It leads to a lot of frustration and anger. Imagine the surprise when new parents received medical bills for the birth of their child when they believed they were fully covered.
Another shortfall is that people often tend to buy cheap, instead of speaking to an independent financial adviser, who does not favour a specific scheme.
It’s vital that you read the fine print before you sign up, as this could prove costly in the long run. Make sure what the exclusions are and whether there are any co-payments or provider networks that you must make use of.
It’s also important to understand the terms used in your chosen medical aid’s brochure. A medical aid may offer 100% cover, but this does not mean you have fully covered no matter the cost.
The 100% cover referred to is the agreed-upon tariff between the medical scheme and the Council for Medical Schemes.
If a doctor feels his or her speciality is worth more, they may charge above scheme tariffs. In short, 100% is a base tariff. If you have 200% cover, you get double the base amount.
Then, there are limits, waiting periods and exclusions.
As a member of a certain medical aid, you may limit to a certain network of doctors. Or a certain amount of obstetric visits during your pregnancy, waiting periods to claim certain benefits. Such as birth benefits or to claim for pre-existing conditions. You may also exclude from certain procedures such as cosmetic dental surgery, nasal surgery or scans.
Make sure you fully understand and know what your limits, waiting periods and exclusions are before signing up to any medical aid.
An essential cover that is often overlooked is gap cover.
This cover refers to a standalone product that enhances your medical aid. There are several different gap cover companies and options available.
Gap cover typically covers things such as in hospital shortfalls (when your doctor charges above scheme rates) and co-payments (when a hospital or procedure costs more than your limit).
Gap cover gives you peace of mind that no matter what, you will have cover if there’s some shortfall.
It’s important to note there are different gap cover products for different needs too. Just because you have gap cover, it doesn’t mean all shortfalls have cover.
Gap cover is very affordable and much less than you would pay for your medical aid.
So to conclude, hopefully, now you have a more clear understanding of the good the bad and the ugly of medical aids.
All info was correct at time of publishing