Navigating between the different medical aid schemes can be difficult but need to consider all of the factors before making a final decision. Picture: Freepik
Image: Picture: Freepik
As we head in to the new year, navigating the medical aid landscape can tricky therefore making informed decisions about private healthcare is critical, especially considering the different options, monthly contribution premiums and the varying benefits.
Lee Callakoppen, Principal Office, Bonitas Medical Fund, said that by evaluating your healthcare needs, understanding the different types of medical aid plans available and comparing the cost and benefits, you take care of your healthcare needs, while staying within your budget.
"The first step is to do a personal healthcare needs’ analysis to determine what cover you need. If you have dependents, factor in their healthcare needs too," Callakoppen said.
"Consider how often you and your family visit a doctor or specialist, what over-the-counter medication or chronic medication you require, specific conditions you may have, how much you spend on dentistry or optometry and whether you have any surgeries or procedures planned."
When you are navigating medical aid market and trying to make a choice, you should consider the following factors:
- Age and lifestyle: Your medical aid needs change at different stages of life, for example younger, healthier people generally need less comprehensive cover while older adults or those with chronic conditions, may require more substantial cover.
- Chronic conditions: If you have ongoing health issues, you need to ensure that the medical aid plan covers this as well as the specific medication and treatment that is required.
- Family planning: If you are planning on starting a family, you need to make maternity and paediatric benefits a priority.
Most medical aids offer a variety of medical plans therefore it is essential that you understand the differences between the plans.
Traditional plans: these plans offer comprehensive medical cover for moderate to high healthcare needs, including hospitalisation and day-to-day costs
Hospital plans: with these plans, only planned in-hospital expenses and emergency hospital admissions are usually covered however many offer some out of hospital benefits also.
Savings plans: these types of plans are a combination of hospital cover with a medical savings account that pays for your day-to-day expenses. After the savings are depleted, you will be responsible to pay for the expenses out-of-pocket.
Network plans: with this type of plan, you will need to you to use specific healthcare providers within a network and they can be cost-effective. Have a look for network hospitals and doctors are convenient and close to you.
Income-based plans: this type of medical aid plan offers specific premiums that are in line with your salary.
Callakoppen said that before making you decision, it is crucial that you weigh the monthly premium against the benefits you will receive in order to get the real value.
This is what you need to consider:
- Affordability: Keep in mind that private medical aid is a monthly commitment and that it should not be more than around 10% of your income
- Benefit limits: Check the annual limits for various treatments and hospitalisation while making sure there is enough cover for chronic conditions and emergencies
- Co-payments: Check for any co-payments as this can have an impact on your out-of-pocket expenses and budget
- Value for money: The cheapest plan might not be the best if it does not offer enough cover for your specific needs therefore you should aim for affordability and comprehensive cover
- Compare options: On the different websites for medical schemes, you can view the plans on offer as well as download the respective brochures which can be a good way to compare the various options
You need do check if the medical aid plan offers cover for preventative care such as free vaccinations, screenings and annual check-ups.
You should also ask yourself the following question: does the plan offer managed care programmes for health issues like diabetes, cancer, HIV/AIDS along with optical, hearing and dental cover which help you manage your health and save you money?
According to Callakoppen, typically there are waiting periods for new members before benefits can be accessed. These waiting periods can range from three months to a year.
A general waiting period generally applies to all new members, regardless of their health status while condition specific waiting periods can apply to people with pre-existing conditions, limiting or excluding those benefits for a period.
In terms of exclusions, you need to read the fine print for any procedures, treatments or conditions that is excluded from the plan.
You should speak to your family, friends or doctor about which plan they are on or for any recommendations. You can also look online for comments or reviews about how the scheme treats its members, the claiming process and customer care.
Callakoppen said that regulations stipulate that medical aid schemes must have a solvency ratio of at least 25% to cover claims.
"Check the credit rating of the scheme and average age of the membership which all impact the sustainability of a medical aid fund," Callakoppen said.
"If you’re feeling overwhelmed at the choices, consider using a broker. Brokers are accredited with the Council for Medical Schemes and can provide expert guidance to help you choose the medical aid plan that is best suited to you and your family’s needs."
IOL
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