How to Choose the Right Medical Aid

January 7, 2015

As another year begins, it might be time for you to consider changing your medical plan. But please choose the right medical aid! It doesn’t matter what your medical conditions are right now, you can still upgrade or downgrade, depending on your requirements.

What’s more, if you have had changes to your health this year that impact you and your family, you can process your plan changes without suffering a waiting period or any exclusions.

But do take note: there’s a cut-off date by which you need to make such changes. Contact your medical aid to find out which date is their cut-off.


Choose the Right Medical Aid Before Changing Your Plan

Before changing your current plan, make sure you understand the following:

  1. What will the higher plan offer?
  2. Will an increase in premiums mean better or more benefits for you?
  3. Will this be a cost effective plan for you and any dependants you have?

Discuss these questions with a healthcare adviser who will help you choose the best plan for your needs and pocket.

How to Choose the Right Medical Aid

Here’s an example: a diagnosed chronic condition that you have just been diagnosed with might only be covered by a more costly plan but you’ll need to consider if the benefits are worth more than the high premium.

What’s more, there are those plans that don’t offer more benefits in the areas you might need them and the money you would spend on a greater premium would be better in a savings account. Always take out a medical plan according to your healthcare requirements.


Choose the Right Medical Aid – Key Considerations When Changing Medical Aid Schemes

1.    What is the best cover you can afford?
A lot of people simply take out the most basic cover thinking they won’t fall seriously ill – particularly if they are younger, healthier medical aid members.  Most basic plans, though, have limited major medical cover, so in a major event like an accident or contracting a chronic illness, that required immediate hospitalisation, members would have to fund these expenses out of their own pocket.
2.    What is the best plan for your health profile and life stage?
Whether you’re young and single, starting a family or retired, choose cover that is best suited to your life stage. Don’t put off taking out medical aid until you really need it and then have to endure exclusions and waiting periods. Also, be sure to upgrade your option as your circumstances change.
3.    What benefits to medical savings accounts fund?

When it comes to comparing medical schemes, don’t just do so based on cost. Take a look at what benefits the scheme covers, like scans or preventative tests and see if they actually cover it as opposed to chewing up medical savings account balances. Another thing to ask about is whether or not the scheme offer an Above Threshold Benefit. This usually allows for more comprehensive cover. It also acts as a safety net for day-to-day medical expenses should you deplete your medical savings account.

Choose the Right Medical Aid – Is There a Network of Hospitals or Doctors?

Schemes that have access to such networks can usually afford medical cover at better premium prices. It’s not actually choice-limiting, but rather a money saver while you still enjoy top quality care.

What Rate Does the Scheme Pay Hospitals, GPs, Specialists and Healthcare Providers?

Some healthcare providers charge above the medical scheme rates, so you need to fund the difference out of your own pocket. Find out which benefits the scheme covers both in and out of hospital. A lot of medical aids require their members to make a co-payment for certain treatments and procedures. Ask the scheme if they cover 100% or 200% of the medical scheme rate.

Choose the Righ Medical Aid – Are there Any Rewards?

Rewards programmes should not be your main reason for choosing a medical aid – it should be all about the quality of the medical cover. Try not to get distracted by such programs or enticing discounts.

How Does the Scheme Manage Administration?

Of course you will want your claims to be processed and paid quickly and easily. Look out for schemes that offer services like being able to download statements and also online submission and tracking of claims.

Medical aids account for as much as 10% of your disposable income. So it’s vital that you take a good look at your healthcare needs before the New Year to see where you can save money without losing out on the cover you and your dependents need.

All info was correct at time of publishing