Choosing a medical aid

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medicine, vaccination and healthcare concept - african american female doctor in mask with syringe over hospital ward background8BIM
medicine, vaccination and healthcare concept - african american female doctor in mask with syringe over hospital ward background8BIM

Many of us are struggling financially and making important decisions on how to cut down on expenses. Covid-19 has highlighted the need for quality healthcare and the importance of having a private medical aid. Although it may be seen as a ‘grudge’ purchase, it is when we face these unexpected and expensive medical costs, that we realise how important it is to have private medical care.

September is when private medical aids ‘launch’ new and amended plans for the year ahead as well as announce premium increases. It’s the time to look at your medical cover carefully, compare it to others and decide which medical aid plan suits you. Look at your budget and see whether you can afford a comprehensive plan or if a hospital plan will be sufficient to cover your needs.

Bonitas Medical Fund has some advice while you go through this process:

1.    Read the small print

It’s important to read all the information about the plans, so that you understand exactly what is covered and what isn’t.

2.    Already on a medical aid?

Have a look at your health care costs over the past 12 months, including:

  • What did you spend on day-to-day healthcare expenses?
  • Was anyone admitted to hospital?
  • Did you need to visit a specialist?
  • How often did you visit a GP?
  • Do you have any chronic conditions?
  • How much was spent on dentistry, optometry and over-the-counter medicine?
  • Did you use up your day-to-day benefits and/or savings in the year?
  • How much did you pay in co-payments and/or deductibles?

 Also consider once-off costs that won’t come up again soon (childbirth) and those likely to come up again (including the flu).

medicine, vaccination and healthcare concept - afr

3.    Pay attention to day-to-day detail

  • Medical aids are not-for-profit and belong to their members. For this reason, they have to ensure they contain costs for the benefit of all their members. So, it’s important to carefully consider the day-to-day benefits and ask:
  • Does your medical aid contract with hospitals, doctors and specialists, are you willing to use them and are they close by? Network providers are there to ensure full or improved cover and charge a pre-negotiated rate. This means that doctors and hospitals on your scheme’s network will not charge more than the agreed rate. Not using network providers will usually result in a co-payment by the member.
  • Check if you need to be referred to a specialist by your GP.
  • Does your medical aid offer additional GP consultations, for which they will pay, after you have exhausted your day-to-day benefits?

4.    Age will influence your decision

  • If you have young children, select an option with enough child illness benefits.
  • Check the maximum age of child dependents.
  • If you’re older, select cover that provides sufficient in-hospital cover in the event of hospitalisation and one that covers chronic conditions.

5.    Are there any additional benefits?

Ask what extra benefits may be available that could save significantly on day-to-day expenses. These could include:

  • Preventative care benefits, ranging from basic screenings (blood pressure, cholesterol, blood sugar and BMI measurements) through to mammograms, pap smears and prostate screening. In some cases, this extends to maternity programmes, dental check-ups, flu vaccinations and more. Look at virtual care options on your medical aid and what value you get from them.

6.    Ensure affordability of the plan

When comparing different medical-aid options, consider all the costs involved before you make your final decision, such as:

  • Monthly contributions – as a rule of thumb, these should be around 10% of your monthly income at an individual or household level.
  • Generally, the lower the cost of the option, the fewer the benefits available to the member regarding medical treatment, healthcare providers and medications.

Empower yourself with information

Take the time to read the information sent to you by the medical scheme or consider using a broker. Covid-19 retrenchments and reduced salaries mean professional advice is even more important as we go into 2020 and brokers are familiar with the details of the different plans and are able to help match you with the best medical cover that suits your budget.

For more info visit Bonitas

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