Does Medical Aid Cover Screening Tests Such as Gastroscopies?
March 29, 2018
The range of cover that you have will depend on the medical aid that you are a member of and what level plan you have. Screening tests such as gastroscopies are not usually included with plans that have just the bare basic cover.
Your medical aid focuses on disease prevention. For this you will probably end up paying a lot more for your cover. But you will also be able to be more proactive when it comes to your health.
Of course, there have to be some limits in place when it comes to screening. For example, Discovery Health will pay for you to have a mammogram every two years, a prostrate screening test every year and a Pap smear every three years.
You will often find that benefits for less common screening procedures are limited. However, screening for issues that could have a much more impactful, immediate effect for health are more freely available.
Most companies will cover you if you need your blood pressure or blood glucose levels checked. They will usually also do cholesterol screening and checks for HIV.
Depending on the circumstances, you might be able to get your medical aid to pay for more advanced screening procedures. Perhaps there is a good medical case and there is a high risk that you could have a certain condition. In that case, the medical aid might pay for the treatment.
Say, for example, that there is a medical history of breast cancer in the family. The medical aid may allow you to have a mammogram every 30 months instead of once a year.
Screening for Children
Again, this will depend on the medical aid that you are a member of and the cover level you have chosen. Many medical aid will cover tests to assess growth, like weight, height, etc. and general health checks.
Maybe you need to have your child checked for less common problems like poor hearing or a learning disability. In that case, there are limits to the cover you are able to access.
Cost is a Huge Factor
Even where medical aids do pay for screening, you might still find yourself having to take money out of your own pocket as well. Specialist doctors do most screening and they do not always charge in accordance with medical aid rates.
This might mean that you will have to make some form of co-payment with each visit.
On the plus side, if you are being screened for a condition that forms part of your prescribed minimum benefits, the costs are deducted from your hospital benefit and not from your day-to-day benefits.
If the conditions does not fall under the prescribed minimum condition list, it will be taken from the day-to-day benefits or out of your medical savings account.
If you want to know for sure which case applies in your instance, it is best to check with your medical aid directly. They will be able to tell you for sure what the answer is.
All info was correct at time of publishing