How to make your medical aid benefits last

Image: Getty
Image: Getty

‘If you manage your medical expenses correctly you can avoid out-of-pocket expenses and limit the possibility of running out of benefits,’ says Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund. 

Van Emmenis, gives some tips on managing your medical expenses to make them last.

Find a GP on your medical aid's network

Using network doctors is an invaluable tool to make your medical aid last longer as it means you won’t be charged more than a specific amount. At present, Bonitas Medical Fund has the largest network of GPs in South Africa - with over 6 000 doctors.

Always use partner networks

Medical schemes negotiate preferential rates with providers who have partnered with them. This means if you use a network hospital, doctor or pharmacy you will not be charged more than the rate agreed with the scheme. This will also help you to avoid co-payments, deductibles and additional out-of-pocket expenses. 

Ask your pharmacist

Buy over-the-counter medicine to treat less serious ailments and consider using generic medicine which is cheaper but effective. Pharmacists are able to provide sound medical advice on problems such as rashes, colds or illnesses that are not severe, simply ask!

Going to hospital – get the facts

Talk to your doctor or specialist before being admitted to hospital. Check what they are going to be charging and what your scheme will cover. If there is a large difference, don’t be afraid to approach your doctor to see if they are prepared to adjust their fee. Alternatively, you can also check if there are other healthcare providers who are on your scheme’s network that will charge you a better rate.

Remember to pre-authorise

Pre-authorisation is required for all hospital admissions to ensure your stay will be covered. Always ask if there are any co-payments or sub-limits that will apply and what you can do to avoid these. For planned procedures, it’s also worth checking with your scheme if you will obtain better cover by using contracted providers or having the procedure performed in the doctor’s rooms or a day clinic.

ICD-10 codes

If you need to undergo an operation, ask your surgeon for the codes that will be charged. This will include the procedure codes and those for any other products that will be needed, this all helps with pre-authorisation and ensuring the costs will be covered. 

Look for schemes that offer benefits paid from risk

These benefits give you more value for money and are in addition to your savings and day-to-day benefits. Bonitas pays for maternity consultations, wellness benefits, preventative care and dentistry from risk on most plans. 

Managed care benefits

Some schemes offer programmes to help you manage severe chronic conditions such as cancer, diabetes and HIV/AIDS. These programmes are usually covered from the risk portion of your medical contribution and are not funded from your savings account. They help you use your benefits to maximum advantage while ensuring you receive quality care by using specific providers.

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