What are Co-Payments in Medical Aid?

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. The member, who may or not be the patient, is then left with a shortfall he has to cover out of his own pocket. Most commonly this relates to medical specialists including surgeons, anaesthetists and other medical and health-related service providers who take care of you in hospital.

The tragedy is that many people think they are fully covered, just because they belong to a medical aid scheme. But when it comes to the crunch, they find out they need to make co-payments to ensure that the medical and health suppliers they have used – and have taken care of them – are fully paid.

The reality is that unless you’re paying premium rates, your medical cover will either be capped or limited in some way. So you’ll be covered, but not necessarily 100 percent covered. This means you are inevitably going to have to chip in to cover the total amount due, which 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, if for instance the plan only covers 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, not only in terms of what you have to pay each month, but also in terms of exclusions and any co-payments that may be required from you if you get sick or are injured 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. If you are confused, 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.