Jill Larkan, Head of GTC Healthcare Consulting on Choosing a Medical Scheme

In a recent interview, Jill Larkan, the head of GTC Healthcare Consulting, made a number of startling observations concerning the difficulty of the choice South Africans face when selecting a medical aid scheme. GTC recently conducted a cost-benefit analysis of 19 open medical schemes. What struck Larkan the hardest in the course of the survey was how little information was available to those shopping for schemes. That is, information they can understand. All they have to refer to are the incredibly technical one-page reports they release every year.

When making the choice of medical scheme, the most important consideration, according to Larkan is the amount of in-hospital benefit it really provides. She insisted that one needs to understand the level of cover a medical scheme is really providing. You need to ask yourself “will this scheme give me the level of in-hospital cover I need?” You must be sure that you’re not taking on more risk than you can handle. You should also be clear on the level your medical cover puts you with regard to out of hospital care. Is your policy just a savings account or does it offer you additional benefits? Or worse, is it not even a savings account?

Jill LarkanThese should be what you think of first when looking for medical cover. After establishing the facts on the in-hospital cover benefits you can then think about the additional benefits, which are numerous and vary greatly from plan to plan. You can also consider if the scheme has rewards such as cash-back offers and the like.

Another hot topic in the world of insurance is the claim by medical aid companies that they cover 100% of medial treatments. The layman assumes that the insurer means that they will cover the complete cost of treatment no matter what it costs. But this is rarely ever the case. As Jill Larkan explained, they really mean 100% of the scheme’s rate for treatment. This rate is determined by the scheme and in many cases ends up being different from what healthcare providers actually charge for treatment.

This is especially true when you’re seeing a specialist doctor. Some schemes, which are mostly those that charge substantial premiums, will have specialists on their network of recommended providers. If this is the case, they will probably really foot the entire cost of treatment. But if you’re forced to get treatment from a specialist who is not in your medical scheme’s network, chances are their charges will supersede your medical cover. And you will have to pay the difference from your own pocket. Most of the queries GTC receives, Larkan says, are due to this misunderstanding of the ‘100% cover’.

The GTC survey divided the schemes into 11 categories in order to determine which offered the best in terms of value for money. They came up with a detailed report which they have made available to the public on their website. If you’re looking for a scheme you can check out the survey and see which companies were ranked highest in each category.