Six things to consider before changing your medical aid cover

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Most medical aids have waiting periods when you join, meaning that they won’t pay out for the first three months that you are a member (for any general claim). Picture: iStock/ Ipopba
Most medical aids have waiting periods when you join, meaning that they won’t pay out for the first three months that you are a member (for any general claim). Picture: iStock/ Ipopba

PERSONAL FINANCE


The Covid-19 coronavirus pandemic has brought a lot of uncertainty over the past few months, with some people having experienced retrenchments, salary cuts and unexpected expenses associated with the cost of being home more than usual.

The pandemic has also brought into stark focus the importance of protecting your health and that of your family.

While some may be considering investing in medical aid, others are looking into changing the cover they have.

However, there are some key considerations before making the final decision because depending on the rules of your scheme, you may not be able to change your specific plan halfway through the year.

Here are six tips when evaluating your medical aid.

1. Out-of-hospital costs

Do you need a hospital plan or a comprehensive plan that includes a medical savings account too?

Assess your out-of-hospital costs in the previous year, including doctor visits, medicines, optometry and dentistry.

Would you benefit from having a medical savings account to fund these expenses, or do you think you can manage on a hospital plan and fund these yourself?

2. Should I choose a medical aid with a network scheme?

Ensure that there are sufficient hospitals and healthcare providers near you before choosing a network scheme. This is one way of bringing your medical aid costs down.

Otherwise you could end up having to use a specialist or hospital not in the network, and then having to make large co-payments.

3. Check those co-payments

For certain procedures and treatments, medical aids don’t refund you the full amount. So it’s worth researching what these are before you commit to a new medical aid plan. Gap cover is one way of meeting this shortfall, as it pays in the difference between the full amount owed and what your medical scheme will pay.

4. What exclusions are there?

Most medical aids won’t pay for a cosmetic procedure that they don’t consider essential. They won’t pay for a self-inflicted injury or for your child’s orthodontist.

So before you go and sign up for a new medical aid option, bear these exclusions in mind, in case they are things you may need cover for in the future.

5. Chronic medication

Do you take chronic medication regularly? If so, you should check the chronic medication benefit that applies on the plan you’re considering, and what your annual limits are.

Also check that your chronic condition is actually covered by the medical aid, and if there are any co-payments, plus what these are.

6. Waiting periods

Most medical aids have waiting periods when you join, meaning that they won’t pay out for the first three months that you are a member (for any general claim).

This is to stop people abusing the system by ensuring that they aren’t able to make large claims shortly after joining, followed by them immediately cancelling their membership.

There are some key considerations before making the final decision because depending on the rules of your scheme, you may not be able to change your specific plan halfway through the year

Medical schemes also have condition-specific waiting periods of up to 12 months.

So if you have a pre-existing condition (including something such as a pregnancy) and know you will need treatment within that period, you need to consider this in your decision.

The health of you and your family are paramount so finding the right medical aid option for your needs is a big decision.

Schemes such as Fedhealth allow you to change your plan (within their scheme) within 30 days of a life-changing event such as getting married, falling pregnant or being diagnosed with a dread disease.

Hopefully, these points will help you evaluate your options and find a plan that suits your life and budget.


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