Ask an expert
Question

13 Feb 2004

Discovery vs Medihelp
Hi,
I have been with discovery for many years and want to change to MediHelp.
Im currently paying(Family of 5) +- R3700 for a classic comprehension + levys on medicine + extra for specialists + end up in a self payment gap of R3000. They don't pay for lower schedule medicine, which is almost all my doctor prescribes.
im contemplating taking Medihelps middle plan (a hospital plan with the added benifit of Xrays/blood tests etc included under the hospital plan) and paying cash for my medicine/doctors visits. This will only cost me R2000 - and that includes a saving of R8000 per year - R4000 less than Discovery.
I understand that the R8000 will eventually run out where discovery just carries on paying. Im sure the R1700/month + levies + gap will cover that.
My biggest worry is this - Do the hospital cover for these two compare? I don't want to sit in ICU with a medical aid that won't pay.
Thanks in advance.
R1700 x 12 = R20400 + R3000 gap + R3000 levies = R26400 = One helluva holiday!
Answer 15,636 views
Expert
medical money

01 Jan 0001

Hi fed-up

Unfortuantely (or fortunately) you are likely to get what you pay for. As medical schemes are meant to be non-profit (after the deduction of the expenses) any surplus in the scheme generated in one year will be used to minimise increases in contributions in subsequent years.

In assessing value for money the first test should be to assess what the levels of charges are, as these are a first deduction off your contribution. The second test is whether there is any reinsurance arrangements within the fund, these ahve benefits in that the risk is passed out of the scheme to a third party but the premium for these may be very high. A third test is the solvency levels of the scheme, the greater the reserves the greater the chance of the scheme being able to pay claims as and when they arise. Regardless of how good benefits might be if the scheme goes bankrupt it is not going to be of much assistance regardless of the benefit structure.

All schemes have to provide prescribed minimum benefits, in order to qualify as a medical scheme. These benefits are unlimited and even though they can prescribe where you go for this treatment you will always be entitled to treatment. Most hospital events require pre-authorisation before going for the procedure and as a result you should always know what is going to happen before finding yourself in an awkward postion.

I am not fully familiar with the benefits of MediHelp but some important things to look out for are: What tariff does the scheme pay the hospital and the doctors. If there is a difference between what the doctor charges and what the scheme pays you will be liable for the shortfall. Some schemes have a prescribed list of hospitals, check that there are hospitals in your area and that they can perform the types of procedures that you would expect. You need to check whether there are any levies or co-payments on hospitalisation. Some schemes also have a maximum overall limit for hospitalisation benefits.

In all events you should remember that any medically related expense can be covered out of your savings account. I think you do need to be careful about the option you select and would always encourage you to obtain independent advice, matching your needs with the product features.

Remember the huge saving that you identified, put it aside in a personal bank account for the first year - you may need to use some of it to top up the differences between what you used to receive and what you may get now by changing options.

Regards
The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical examination, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.
Voting Booth
Have you entered our Health of the Nation survey?
Please select an option Oops! Something went wrong, please try again later.
Results
Yes
33% - 9369 votes
No
67% - 19364 votes
Vote