Medical Aid Plan - Beware of Medical Payout Ceilings

Beware of Medical Payout Ceilings


It is alarming to learn just how many people are not fully aware of the terms and conditions that apply to their medical aid plans. There is no plan that offers unlimited cover, regardless of what the scheme says or promises. All plans feature ceilings and it is vital that members of medical schemes are aware of these ceilings.


What do they mean by a ceiling?


Medical Payout CeilingsMedical schemes place a limit on the amount of money that can be claimed for medical expenses. When this limit is reached, the member does not enjoy cover any longer. The following points are salient and should be considered when evaluating medical aid plans:


ยท             Many medical schemes say that they offer full in-hospital cover but what they mean is that they will cover treatment only at the approved medical aid rate. Many hospitals and doctors charge much, much more than this approved medical aid rate and members that thought that they were fully covered find to their shock that they are liable for the difference. In cases of hospitalization this difference can be a substantial amount of money.

  •              Some schemes offer their members medical savings accounts. The member uses the money in this account to pay for day-to-day medical expenses. However, the amount that is available is limited and once the account is exhausted the member has to pay for further medical costs. There is more: medical schemes categorize medical expenses and each category has a separate limit. It is therefore perfectly possible to have funds available to pay for, say, dentistry but have no funds to pay for a visit to a general practitioner. 
  •              Some schemes carry unused funds over to the next year but others do not. It is vital that members make sure what happens to unused money. 
  •              Many schemes require their members to make use of service providers that they have approved. In most cases the scheme enters into an agreement with these service providers and if members want to use another professional, they are liable for the cost. 


How to protect yourself against unexpected medical costs


  •            It is of the utmost importance to study the terms and conditions of a medical plan and to keep careful record of expenditure as the year progresses. If the limits are regularly reached, it may be necessary to upgrade the cover enjoyed. 
  •              It may be useful to purchase additional medical insurance. Some companies offer excellent cash-back insurance policies that will pay a specified amount for each day spent in hospital. This money can be used to cover the shortfall. 
  •              Communicate with the medical scheme prior to undergoing expensive treatment or before being admitted to hospital. In this way unpleasant surprises can be avoided. 
  •              Be realistic when selecting a medical aid plan. It may be a good idea to ask a doctor to perform a thorough risk assessment. People with a family history of a specific disease or condition must accept that they are also at risk and that they must make provision for the treatment of such conditions.  

Many people have found themselves in a position where they have to pay a hefty medical bill while they were under the impression that they were covered. The importance of studying the exact nature of the cover provided by a specific plan simply cannot be overemphasized. Avoid medical payout ceilings before they happen. © Medical Aid Plan




Medical Aid QuoteNOTES:

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.