Presented by Bonitas

Choosing a medical aid

 ·1 Sep 2022

Everyone is feeling the pinch and looking for ways to stretch their budget. This is true of healthcare too, especially when it comes to private medical cover.

When choosing a medical aid, the smart move is to do due diligence to ensure you get the cover you need, that works for you and your family and is within your budget.

Then it’s important to manage your medical expenses to make your healthcare benefits last.

‘There are 17 open medical schemes in South Africa, each with their own set of plans and benefits,’ explains Lee Callakoppen, Principal Officer of Bonitas Medical Fund.

‘It can be confusing trying to decide on what plan is best for you and your family. We advise consulting a medical aid broker or financial advisor.’

Brokers are accredited by the Council of Medical Schemes and are suitably qualified to offer advice and support and there is no extra charge for this service.

Together you can work your way through the different options, ahead of choosing a medical aid plan best suited to your health needs.

Brokers also know the financial stability of the schemes, which should be a consideration in the final decision.

A starting point, with or without a broker, is to compare what is available. Most medical schemes offer a range of healthcare options – from traditional medical aids through to hospital, savings, network or income-based plans that can make private healthcare more affordable.

Things that need to be considered:

Your healthcare needs

Do a quick personal healthcare needs’ analysis to determine what cover you need. If you have dependants, factor in their healthcare needs too. Consider the following:

  • How often you visit a doctor or specialist
  • Over-the-counter medication or chronic medication required
  • Chronic conditions (like high blood pressure or diabetes)
  • Specific conditions such as cancer, HIV/AIDS or renal failure
  • How much you spend on dentistry or optometry

Then consider which expenses were once-off (like childbirth) and which are likely to come up time and again – such as flu.

This will help you decide on whether you need a comprehensive medical aid or a hospital plan.

The fine print

It’s important to take the time to read the information sent to you by the scheme and/or your broker. Benefits vary from plan to plan, so analyse the details to establish what is and isn’t covered.

Ask what supplementary benefits might be available that can potentially save significant day-to-day expenses.

These could include preventative care benefits, ranging from basic screenings for blood pressure, cholesterol, blood sugar and Body Mass Index (BMI) measurements through to mammograms, pap smears and prostate testing.

In some cases, these extend to maternity programs, dental check-ups, flu vaccinations and more.

Once you understand what is on offer, you can make an informed comparison and decision.

Managed Care options

Managed Care programmes help members manage severe chronic conditions such as cancer, diabetes and HIV/AIDS.

Check whether the scheme you are considering has a managed care programme.

Medical savings

A medical scheme allocates an annual fixed amount for medical savings – you need to know what this allocation is and whether you feel it will be adequate for your needs.

Daily detail

Look at what the scheme suggests will help make your benefits last, bearing in mind the following:

  • Are you required to use a specific GP, hospital network or Designated Service Providers (DSPs)? Although this helps keep costs down, because the scheme has negotiated special rates with these services providers, you need to check the network in your area before making a final decision
  • Having to be referred to a specialist by your GP?
  • Does your medical plan offer additional GP consultations, which they will pay for, after you have exhausted your day-to-day benefits?

Virtual Care and technology

Technology and virtual care are being embraced by medical schemes and members, even more so since the Covid-19 pandemic.

Check what is offered on the plan you’re considering and whether you’re able to access your benefits and medical information 24/7.

Age will impact your decision

As parents of young children, you need to ensure that the medical aid option you select provides sufficient child illness benefits.

For young couples planning a family, check the maternity benefits. If you’re slightly older, you might choose an option that covers chronic conditions and provides sufficient in-hospital cover in the event of hospitalisation.

Affordability is key

Consider all the costs before you make your final decision:

  • Monthly contributions: The rule of thumb is that these should not exceed 10% of your monthly income at an individual or household level
  • The cost of co-payments. A medical aid co-payment is a fee that the member is liable for when making use of certain medical services. These co-payments usually apply to specialist or elective medical procedures and differ from one medical aid scheme to another. It is one of the reasons why you should always do thorough research, before deciding which medical aid scheme is the best option for you. The ideal option would of course be the one that does not require any or very little co-payments from the member.

Waiting period and exclusions

The Medical Schemes Act and the specific scheme’s rules determine this. Callakoppen recommends that you enquire with the relevant scheme about their exclusion list and waiting periods.

‘Health is the new wealth,’ says Callakoppen. ‘Your health is important, as are your finances, don’t take either for granted.’

‘When it comes to healthcare cover, invest time in researching and understanding the medical aid plan you’ve selected. Read the information sent to you, including the fine print to understand the Scheme Rules.’

‘If in doubt, phone the call centre, your broker or financial advisor. This will go a long way in helping you know your rights and making the most of your benefits.’

Click here to learn more about Bonitas. 

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