The rising?cost of health

2013-10-13 14:00

Before you default to the same option you are currently on, you need to check a few details to make sure you get the best value out of your medical scheme. First, you should examine your medical expenses over the last year and then think about how those expenses are likely to change over the next five years. Just like most things in life, your requirements from your medical scheme will change as you go through different life stages. Neesa Moodley-Isaacs reports

»?Single or married with no children

For young people with no children, basic cover for unexpected medical and emergency events is generally sufficient. This type of cover is typically found in medical schemes’ hospital options.

If you are considering starting a family, you should add some level of day-to-day cover in addition to generous maternity benefits.

Good maternity benefits are essential so you are covered throughout pregnancy and during birth, as well as for any complications your baby may have after the birth.

Plan ahead and upgrade to a more comprehensive option when you are planning to start a family as most schemes have waiting periods, which can be up to 10 months, to prevent people joining just to claim maternity-related benefits.

»?A young family

When children are young, common illnesses typically require regular day-to-day benefits, which are covered by benefit options that offer generous out-of-hospital benefits such as GP visits, dentistry and medicines.

This cover can then be reduced as children grow older.

Families with young children are some of the highest claimants from medical schemes, so choosing a more comprehensive plan, such as a network plan that covers out-of-hospital expenses, like visits to the GP as well as immunisations, could end up saving you money in the long run.

»?Middle age

During these years, you may start developing certain chronic conditions. These conditions require regular medication and monitoring to ensure they do not cause further complications.

Common concerns as you grow older include heart disease, cancer and osteoporosis.

Most dread diseases develop during these decades, so a plan that pays for chronic medication should be a key consideration.

Eye and hearing assessments should also be on your check list, so investigate whether they are covered out of your benefits or savings.

Be aware that fewer and fewer companies are offering postretirement medical aid benefits so you need to set aside money and make plans to ensure you can cover your medical costs in retirement.

Questions you need to ask

How does the contribution increase affect you?

1 Be aware that some schemes may announce lower premium increases but could be cutting some of the benefits. This means you need to understand the underlying benefits. Also, don’t just accept the covering letter stating the average premium increase. What matters to you is the premium increase on your specific medical scheme option.

Is your scheme financially viable?

2 Check the claims paying ability of your scheme to ensure that it is financially stable.

For example, Liberty Medical Scheme recently earned a strong rating of AA- from Global Credit Rating, reaffirming its solid and stable claims paying ability for its 118?000 beneficiaries.

According to the scheme’s executive principal officer, Andrew Edwards, by maintaining its solvency level above the statutory requirement, the scheme has “given members the assurance that their contributions are well-managed and taken care of”.

What preventative cover are you being offered?

3 Some schemes pay for preventative tests from risk cover such as annual health assessments, pap smears, cholesterol tests and annual dental checkups.

They may also pay for oral contraceptives from risk cover.

For example, Fedhealth and Liberty Health pay for MRIs and pregnancy scans from risk cover, while other schemes may consider this a day-to-day procedure.

Other schemes will encourage you to go to the gym, have preventative tests and to follow a proper health plan if you have a chronic condition.

Is your chronic condition covered?

4 If you have a chronic condition, all related expenses are paid from your chronic cover and do not affect your day-to-day savings.

All medical schemes have to cover you for 27 chronic conditions as part of the prescribed minimum benefits.

This includes conditions such as diabetes, cancer, asthma and HIV. Some schemes, such as Liberty and Fedhealth, have options that extend that cover for additional chronic illnesses. Liberty has cover specifically for families with young children that include chronic cover for acne, eczema, attention deficit disorder and allergic rhinitis.

Some of Fedhealth’s options include additional cover for disorders related to anxiety.

So if you have a chronic condition that falls outside the prescribed conditions, it is worth investigating which medical schemes would cover you.

Does your scheme offer a network option?

5 Your scheme may offer a doctor and/or hospital network option, which can be much cheaper than a comprehensive benefit option.

Check if the doctors and hospitals included in the network are easily accessible to you. If you use this option, your GP visits could continue to be covered by the scheme long after you have run out of day-to-day benefits.

What are the changes to the medicine formulary?

6 Most medical schemes have a list of approved medications for which they provide full cover.

This list is reviewed periodically and subject to change, which could be problematic in cases where medication previously on formulary is removed, leading to reduced cover for members.

Check whether the medication you are using has been affected by changes to the formulary.

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