Is Your Medical Aid Sufficient Health Cover?

Many people live under the illusion that they are
fully covered for their medical expenses and only find out that they are not when they are faced with massive
bills.
Health Cover
Most members of medical schemes cannot rest assured that they will be able
to claim all medical expenses from their schemes: in most cases there will be a self-payment
gap.

When will my medical aid not be sufficient?

There are several reasons why members may be
required to pay certain treatment costs themselves. The most important of these are as
follows:

  • If your medical savings account is exhausted,
    you become responsible for further expenses.
  • Most plans have treatment limits. If you
    exceed this limit you will be held liable for further expenses. You need to make sure that you are fully
    informed about the limits set in your specific plan.
  • Your medical practitioner may charge more
    than the rate that will be paid by the medical scheme.
  • The scheme may refuse your claim if they are
    of the opinion that your condition does not feature on the Minimum Benefits list. There are approximately 300
    conditions on this list and it may be wise to check with the medical scheme before undergoing
    treatment.
  • You may have exceeded the limit for the
    management of certain conditions such as asthma and various cancers.
  • You may have decided to opt for treatment
    that is specifically excluded by your medical scheme and which is described as “self-payment”. In some cases
    the scheme will pay only a portion of the cost. It is always a good idea to check with the scheme before
    agreeing to any treatment.
  • If you suffer from cancer, the chances that
    the scheme will meet all the costs are very slim indeed.
  • If you require synthetic body parts such as
    will be the case with hip replacements, heart transplants, or if you use devices such as wheelchairs then you
    will have to accept the fact that the scheme will not pay for top-of-the-range
    models.
  • Very few plans make provision for organ
    transplant. If you require a transplant you should check with the scheme
    immediately.
  • Patients that require prolonged
    rehabilitation often find that their schemes will only cover the cost for a short
    period.

What can I do about it?

There are a number of steps that will help to
lessen the shock of unexpected medical expenses:

  • Make sure that you study the terms and
    conditions of your specific plan very carefully. It may also be wise to choose a plan that can be upgraded when
    circumstances demand such a step. If you have questions, ask your medical broker or your scheme to explain the
    uncertainties.
  • Always check with the medical scheme before
    visiting a specialist or hospital or before agreeing to treatment and surgical
    procedures.
  • Think about increasing the size of your
    medical savings account. In this way, you can build up an emergency fund that will be extremely helpful when you
    are faced with major medical expenses such as cancer treatment or organ transplants, for
    example.
  • Do not be intimidated if you suffer from any
    of the conditions that are on the Limited Benefits list. Your medical scheme has to cover the cost in full. If
    a dispute arises you are entitled to approach the Council for Medical Schemes.
  • It is against the law to belong to more than
    one medical scheme, but nothing stops you from purchasing additional health cover through medical insurance policies. Many
    insurance companies also offer gap cover. © Medical Aid Plan

 

COMPLETE THIS FORM TO GET YOUR MEDICAL AID
QUOTES!

COMPLETE THIS FORM TO GET YOUR MEDICAL AID QUOTES!

NOTES:

Your medical aid quote will include options to suit your pocket. Please ensure that the cover you
select is exactly what you need and that you understand exactly what insurance you are buying. Do not hesitate to
ask questions about the medical aid or hospital cover you choose.

Published:

Updated:

Latest posts

Share via
Copy link