Medical aid schemes can be confusing, with some appearing to offer a lot… Until you study the fine print. You’re probably spending a hefty portion of your monthly income on health cover, so make sure you’re on the right plan.
1. Hospital plan or full cover?
Hospital plans are usually more affordable than full-cover plans, unless you or your family members are regulars at the doctor’s office, suffer from ongoing health issues, or have expensive prescriptions that require routine filling. If you’re generally healthy, a hospital plan may make more financial sense. It’s also worth noting that even hospital plans cover you for prescribed minimum benefits, which include 25 chronic conditions, any emergency conditions, and a limited set of 270 medical conditions.
2. What can you afford?
Everyone wants to provide the most comprehensive cover they can for their families, but it’s necessary to assess your finances realistically. Your income may not stretch far enough to afford full cover, so it’s important to examine what’s on offer carefully. When choosing a plan, compare which options provide the best deals for family cover and what your monthly contributions would be. Be wary of ‘too-good-to-be-true’ insurance plans that pay out per day spent in hospital, as these very often aren’t sufficient to cover even a small percentage of the medical costs involved.
3. What are the benefits?
Go through the benefits of medical aid plans with a fine-toothed comb, as they may appear to cover the full amount in a variety of situations, but might actually provide inadequate savings and day-to-day limits. If the savings are small, you could quickly exhaust your day-today coverage. It’s also worth checking what they offer versus how much hospitals really charge – you may find that you’re discharged with a hefty bill, as private hospitals can be vastly more expensive than medical aid rates. You may want to consider an option that pays 200% or more of the medical fund rate for hospital treatment.
4. Are there refusals to consider?
Be aware that certain plans may refuse to allow you to claim for specified conditions for a limited period, although not longer than a year. You also may not be able to receive day-to-day benefits within the first three months of signing up, so make sure you’re aware of all exclusions that could affect you before you commit.
5. What’s the overall hospital limit?
The overall limit in a plan may seem perfectly reasonable, but consider that it applies to all family members covered by the same plan. If the entire family were to be affected by an accident or illness at the same time, the total pay-out amount would have to be divided among everyone, which may not be sufficient to provide for everyone’s care.
6. What’s the scheme’s pay-out record?
Do some research into your chosen plan’s pay-outs online and speak to your healthcare provider or nearest hospital to find out if they’ve experienced any notable issues when it comes to particular plans covering treatment.
7. Are the providers reputable?
Do some research into how reliable and reputable the medical plan provider is. It’s essential that they’re financially solvent – by law, medical aid plans must have at least 25% of members’ annual contributions in reserve. This is essential information, as the last thing you want is for the company to go bankrupt and find yourself in hospital with none of the coverage you’ve already paid for.
8. Do you need professional advice?
If you’re unsure of which plan is best for you and your family, or are overwhelmed by all the options on offer, seek professional advice from an independent broker. As they’re unattached to any particular plan and aren’t paid to promote one over another, they’re able to help you reach a decision based on your specific needs, according to which
can offer you the best benefits for your money.
COMPILED BY CAITLIN GENG PHOTOS: STOCK.ADOBE.COM