Understanding Medical Aid

What is medical aid? Every South African has the constitutional right to have access to health care. The public health system is well regarded and compares very favourably with the care offered by first world countries such as the United Kingdom and the USA. Unfortunately, the public system is over-burdened and underfunded. It cannot provide individualized care for everybody.

Understanding medical aid   

People that can afford it opt for private health care. They become a member of a medical scheme and they choose a specific plan from that scheme. These plans make provision for treatment by private doctors, specialists and hospitals. Members of medical schemes are generally able to obtain better treatment and they have access to the latest technology and protocols.

Understanding medical aid and choosing a medical scheme or a medical aid plan

There are a number of factors that need to be taken into consideration when you are going about understanding medical aid and choosing a medical scheme. The following are some of the most important considerations:

•        Medical aid schemes are strictly regulated in South Africa. They have to keep certain cash reserves in order to make provision for the payment of claims. South African consumers are protected by the law but it is still the responsibility of every individual for understadning medical aid schemes and ensuring that he or she deals only with reputable schemes. 
•        There is a myriad of different plans available and it can be very difficult to compare the benefits of the various plans with each other. The first step should be to assess one’s own needs. Young, healthy people with no family history of dread diseases may need no more than a hospital plan that will cover their cost if they should be involved in an accident or during emergencies. Older people and families with children may need more comprehensive cover. It may be best to consult an independent medical broker to decide upon the benefits that will be needed. 
•        It is also vital to choose an affordable plan. Many people want full cover but then struggle to pay for it. It is important to budget and to choose a plan that can be afforded. 
•        Some medical schemes boast that they pay provide a hundred percent cover. This is not always the case.  What they actually mean is that they will pay a hundred percent of the bills at approved medical aid rates. In reality, many doctors and hospitals charge much more than this rate; in fact the actual cost can be as high as four times the approved rate and the member will be liable for the difference. It is very important to ask the scheme exactly what they will be paying. This is an important point when understanding medical aid. 
•        Every medical aid plan has certain exclusions. It is also important to study those exclusions. If a disease is contracted or a procedure becomes necessary and it is not included in a plan the member will have to pay for that treatment, medication or service personally. 
•        Every plan has certain terms and conditions and members must make sure that they understand them. Some schemes require there members to make use of approved service providers only and if they fail to do so they will be held liable for the cost. If the terms and conditions of a specific plan are not acceptable, then it would be best to look at a different plan or even another medical aid scheme. © Medical Aid Plan

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.