What are Co-Payments in Medical Aid?

April 13, 2015

Even though most medical aid schemes cover hospital and other costs at a rate of what is said to be one hundred percent, the reality is that there are often medical costs that are not covered by the plan. These are co-payments for the member’s account.

The member, who may or not be the patient, then has a shortfall to pay. Usually this relates to medical specialists including surgeons, anaesthetists and other medical and health-related service providers.

The tragedy is that many people think they have full cover, just because they belong to a medical aid scheme. But they find out they need to make co-payments to pay medical and health suppliers.

In reality you you will probably have only limited medical cover. So you’ll have cover, but not necessarily total cover. So you are inevitably going to have to chip in to cover the total amount due. And that is what co-payments are all about.

Co-Payments Explained

Medical Aid Co-PaymentsMedical aid co-payments are essentially a portion of any account related to the medical aid plan that is not covered by the plan, and these co-payments are therefore the responsibility of the member to pay. Often there are specific procedures that have a limit in terms of what the medical scheme will pay. The balance outstanding in terms of any particular procedure is therefore the liability of the member.

Co-payments may also relate to a portion of the member’s account as a whole.

For instance, the plan may only cover a particular percentage of any treatment.

How to Find Out if Your Medical Plan Calls for Co-Payments

It is always essential to find out exactly what any medical plan offers. And not only in terms of what you have to pay each month. But also in terms of exclusions and any co-payments that apply if you get sick or are in an accident.

Most medical aid schemes offer more than one medical plan option, and they generally provide potential members with a comparison of what these different plans offer. Before you decide which plan to sign up with, research all the different options. To clear up confusion, call the medical scheme, or go to a broker for assistance.

Eighty Percent Co-PaymentEither way, ask specifically for information about co-payments and how these will impact you in the event of illness or injury.

How to Avoid Co-Payments

The best way to avoid co-payments is to take out gap cover that will protect you from any unexpected costs you might face when and if you are hospitalised. Gap cover literally provides cover for those account “gaps” you haven’t budgeted for. Instead of being forced to use savings or even possibly borrow money to cover any additional you didn’t expect to be faced with, gap cover is the answer.

The law is strict in terms of gap cover, and only people who belong to a medical scheme are eligible for this form of cover.

All info was correct at time of publishing