Rates increases - benefit decreases

Medical schemes announce their rate increases and benefit changes annually. Do you really understand what this means for you as an individual? Why are these changes made and will you retain all of the benefits you signed for at the conception of your medical cover?

Membership premiums usually tend to rise each year, as a result of inflation and ever escalating hospital costs, but higher monthly premiums do not necessarily equate to improved benefits.

Clinton Alley, Executive Principal Officer for Medshield Medical Scheme, comments, "It is vitally important that consumers know what they will be paying out during the year ahead and also what benefits they can access. Too often members fail to check what changes have been made to their options and this could have major financial implications."

To avoid having claims rejected because benefits have been squeezed or worse still, having to downgrade to an inadequate option, Alley suggests you consider the following checklist of tips:

  • Each year ask various schemes for quotations for a package that suits you and your family needs and compare prices. Alternatively, ask your broker to keep you up-to-date on what's happening in the market.
  • Properly evaluate your and your dependants' state of health. If any of you suffer from chronic complaints not covered by a hospital plan, aim for comprehensive cover that offers generous day-to-day benefits all year round. If you have sight or dental problems choose an option that covers them comprehensively.
  • Think about your financial situation. If you earn R6, 000 a month you can't afford comprehensive cover of R3, 000. Establish how your family structure will affect your monthly contributions. See which scheme and option offers the best, most affordable cover and ascertain your monthly contributions.
  • Before you sign, establish how healthy the scheme's financial affairs are - brokers or the CMS (Council for Medical Schemes) can help - and enquire about its record for paying out (ask hospitals if they've had problems with a particular scheme). You don't want to be with a scheme that lets you down when you need it the most.
  • Read the fine print of the benefits scale. If at first glance a scheme seems to payout 100 percent for just about everything you may feel safe, but pay attention to annual limits.
  • Pay attention to all the exclusions under your option. Several schemes have instituted levies on specific hospital procedures or simply don't cover certain procedures or items.
  • Insist on prescribed minimum benefits. The CMS offers a list of all of them, with descriptions of treatment for chronic conditions that the law requires every medical scheme to cover.

Medical schemes should always design healthcare options to suit the varying needs of their members. And this process is undoubtedly constantly evolving. As a scheme member however you really need to keep a close eye on the annual changes made to your option, otherwise you may find yourself paying over the odds for cover that no longer meets your needs.

(Traffic Integrated Marketing, March 2009)

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