Choosing a Medical Aid Plan
One of the most important decisions South Africans face is the kind of medical cover 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 for most potential subscribers. Before you sign up to any plan you want to know how much of your salary it will demand in monthly premiums. You also need to consider how much it will cost to cover dependents. If you want to add beneficiaries over and above your spouse and children, how much will you need to pay for each of them?
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 from your own pockets should the cost of your treatment be higher.
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 will be factored into 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.