How to Determine if Your Medical Scheme is Worth It
January 27, 2015
Your membership fees for a medical scheme are higher. You are not sure whether to take a hospital plan since you don’t know if it’s worth it. Many healthier and younger people are not sure what to do.
There are two main differences between a full medical scheme and a health insurance. A hospital plan is lower in cost as compared to a medical scheme. But you will have to cover your daily hospital costs on a hospital plan.
The law requires both medical scheme and hospital plan to cover a total of 26 chronic diseases .Your scheme has the right to insist that you get your medication from a designated medical provider. Failure to do so, you will have you make copayments. Before switching to a specific plan, you should consider the following:
• Worth it? – Your medical needs
You should first consider your medical needs. If you won’t have high daily costs and are healthy, a hospital plan will be enough for you. However, if you are experiencing medical problems, you might suffer financially as a result of expenses in the hospital.
• Worth it to join a medical scheme?
When making a medical scheme decision, you should consider the medical history of your family. Keep in mind that there is a high possibility that a sudden chronic condition can bankrupt you. According to the law, you can be excluded from treatment for a period of one year as a result of your current age. The main reasons that explain the causes of medical inflation include: government’s regulations on medical schemes, prescribed benefits and the scheme cannot turn down new applicants.
• Check the cost of your hospital cover to figure out if it’s worth it
Some medical schemes will pay 100% of your fund rate while others will pay 50% of the rate. You should watch out since some private doctors’ charge four times the fund rate. Some hospital plans and medical schemes have specific regulations on treatment of cancer, emergency services, organ transplant, HIV AIDS treatment, artificial limbs, dental surgery, ambulance and other medical appliances. Check the treatments that are not covered and the regulations regarding the limits.
• Check if there is a designated provider
Before making a decision, you should read the small print to determine whether there is a designated provider. Many medical schemes have negotiated deals with specific hospitals thus limiting your choice and reducing costs. Medical schemes and hospital plans fall under medical schemes council. Before joining a scheme, you should check if it has low limits or insufficient medical cover when more than three dependents are involved in an accident
• Check your savings
If your total finances are tight, you should choose a hospital plan rather than a medical cover since a hospital plan is usually cheaper than a medical cover. You should add up your daily medical expenses to check if the price can cancel out the difference between medical scheme and hospital plan. Some medical plan stipulate that you must use a specific network which is fine and can bring a pleasant surprise to you.
All info was correct at time of publishing