Top 10 Things to Look For in a Medical Aid Scheme

When considering the myriad of medical aid schemes that are available in South Africa it is not surprising that consumers become frustrated and confused when trying to compare medical schemes. It is difficult to compare apple with apples because medical aids all recommend different plans that offer wildly differing benefits. We have attempted to list the top 10 things to look for in a medical aid scheme — important aspects to consider when evaluating the various schemes and the plans on offer:

1. 1.Your Own Medical Needs.The level of cover that would be best for you and your family depends upon your unique needs. If you already suffer from a chronic condition or if there is a history of such diseases in the family, it may be better to consider more comprehensive cover. Fit, young and healthy people may need no more than a hospital plan.

2.   The Cost of Medical Cover. Unfortunately, medical treatment is expensive and many plans offered by medical aid schemes are costly. It is necessary to be realistic and to decide what portion of the budget can be used for medical cover. Some schemes offer savings accounts that can help limit the cost.

3.  The Solvency Ratio of the Scheme.Medical schemes are required by law to keep certain cash reserves available to make provision for claims. Any scheme that refuses to make its solvency ratio known should be treated with extreme caution. Schemes with a low ratio are more likely to demand huge increases every year.

4.   The Way in Which the Scheme is Administered. It is certainly worth it to conduct some research on the level of client service offered by the various schemes. Consumer feedback sites can be extremely useful for this purpose. Also find out exactly how quickly claims are processed and to what degree members have access to assistance and advice.

5.   What Are the In-Hospital Benefits Offered? Almost all schemes say that they cover a hundred percent of in-hospital costs. It is vital to understand, however, that this may be no more than 100% of the approved medical scheme rate. The actual cost of specialists, procedures and medication may exceed the medical scheme rate and members are liable to pay those shortfalls. It is therefore vital to obtain a clear idea of exactly what in-hospital benefits are offered by a specific scheme.

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6.   What Are the Out-Of-Hospital Benefits Offered? Some people are surprised to learn that their cover comes to an end as soon as they leave the hospital. It may be best to opt for a plan that offers a savings plan that can be used to cover these expenses.

7.   The Matter of Medical Aid Exclusions. he only way in which to avoid disappointment and financial loss is to make sure that you know exactly what is covered and what not. In some cases, it is possible to buy additional cover to make provision for exclusions in the main policy.

8.   The Issue of Co-Payments. You need to know when you will be required to pay a portion of the cost of certain treatments and procedures. If in doubt, ask for clarification in writing.

9.   What Level of Chronic Medication Cover Is Offered? Over time, chronic medication can cost a small fortune. It is, therefore, important to determine just what cover the scheme offers in this regard. Some schemes will only pay medical rates and others will only fund certain medicines.

10. What About Dread Diseases Such As Cancer? Nobody can rest assured that they will not contract a dread disease such as HIV, cancer, and a host of other conditions. It is worthwhile finding out what medical cover for these conditions is offered and whether medication is included in that cover. © Medical Aid Plan

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