Choosing a Medical Aid Plan
July 16, 2015
One of the most important decisions South Africans face is choosing a medical aid plan to purchase. Before you invest in any one plan, you want to be sure that you get real value for money. For this to happen you need to factor in a number of consideration. Here they are:
Budget: This will be the most important consideration when choosing a medical aid plan. Before you sign up to any plan find out how much of your salary it will demand in monthly premiums. You also need to consider how much it will cost to cover dependents. How much will it cost to add beneficiaries over and above your spouse and children?
Benefits: What percentage of the fund tariff will the plan cater for? While some will only cover 100%, others will still pay for your medical expenses if it goes to 500%. If the scheme only pays 100% of the agreed tariff, you will need to meet the extra costs yourself. That is, if the cost of your treatment is higher than the medical scheme will pay.
Co-payments: Some schemes will require you to make a co-payment whenever you visit one of the healthcare providers in their network.
Status: Your status in life affects your premiums regardless of which scheme you approach. Whether you’re single or married will determine how much you will be required to contribute to your health insurance, as will your age. Your level of activity and the risk you expose yourself to in the course of your work or hobbies will also be factored in when your premiums are being calculated. Expect to pay higher premiums if you’re into such high-risk sports like paragliding and mountaineering.
Network hospitals: You need to find out if the medical scheme in question requires you to visit only the healthcare providers in their network. And if they do, you should be able to find hospitals within that network that are within easy reach. While you can use hospitals that are not part of the medical scheme’s network, you will have to incur out-of-pocket costs. Also consider the hospitals in your scheme’s network and find out if they are equipped to cater for your envisaged medical needs.
Choosing a Medical Aid Plan if you have a Chronic Illness
If you suffer from any of the maladies that fall under Prescribed Minimum Benefits (PMBs), you should know that whichever medical plan you’ve subscribed to, your scheme should meet the cost of your treatment in full. Among the conditions listed under PMBs are HIV, diabetes and TB. The law, enforced by the Council for Medical Schemes, requires medical cover providers to foot all attendant medical expenses.
All info was correct at time of publishing