Traditional option - pre-defined benefits and limits, from expensive, comprehensive plans to limited, more affordable plans.
Benefits are in rands or fixed number of consultations and treatments.
New-generation options - in hospital benefits with a medical savings fund for day-to-day costs.
You can spend the funds as you wish, within certain limits. The full annual amount is credited to your account at the beginning of the year. Any year-end balance is carried over to your next year. Once savings are spent you pay further costs that year, except if you have a plan with a above-threshold benefit. Then, once your claims have added up to a pre-determined amount and your savings are used, the scheme pays further costs that year. Some thresholds are limited.
Network options - you choose to use providers linked to the scheme and get discounted premiums. Networks of hospitals, doctors, pharmacies, optometrists and dentists. This does no mean you receive sub-standard treatments. A good network medical scheme should ensure that it contracts with practitioners who provide quality care, and that its members claims will be paid in full.
Most premiums are related to your income, so those with lower incomes can still join a medical aid.
What cover do you need?
The greater your cover - the higher the premium! So it is vital you have an idea of what you want from a medical aid.
100% or 200% of scheme rates
At the beginning of the year medical aids meet with providers to determine a basic rate for services. This is known as the medical aid rate or 100% of scheme rates. Private providers can charge up to 5 times this rate.
More expensive plans pay up to 2 times this rate, reducing any potential in-hospital shortfall you may incur.
Some schemes require you to use a listed provider in which case your costs are paid in full.
Many schemes are also introducing co-payments for certain procedures, both in and out of hospital.
IN YOUR 20'S: THE HOSPITAL PLAN. Young and healthy, you may have little need for doctor visits and medicines. BUT, we live in a violent country and you do need cover for emergencies and trauma and maternity.
You do not wnat to rely on your family to pay medical costs!
You are laying the foundation for your future health, so ensure you get preventative care benefits.
IN YOUR 30’S: AFFORDABLE COVER FOR A FAMILY. With children, you need a more comprehensive plan - hospital, GP, chemist, dentist and optical benefits. But, these are expensive and you may want to consider a cheaper plan that uses network providers?
Prevention is better than cure, so you need regular dental, cholesterol, glucose and blood pressure tests.
Pregnancy is expensive! Ensure your plan covers you throughout pregnancy and birth. Consider a more comprehensive option before you plan to start a family. Medical aids will not cover pregnancy if you have already conceived.
IN YOUR 40S, 50'S AND OLDER: THE MORE COVER THE BETTER With age comes the need for more comprehensive benefits.
Heart disease, cancer, osteoporosis and dread diseases develop during these years, so you need a plan which pays for chronic medication.
If you can't afford to join a comprehensive scheme then choosing an in-hospital only plan or a network plan will be way better than nothing at all!
Discovery Health's KeyCare plan is the best of these network type plans. It the 3rd largest plan in South Africa. There must be a reason for that!
Whatever you may do, never be without hospital cover!
If you want some out of hospital benefits, the Smart plan offers unlimited, network hospitalisation and a co-payment should you need a network doctor, medicine, dental and optical treatments. The best of both worlds!
Medical aids pay claims at different rates. Medical providers and medical aids decide on the cost of a procedure - the medical aid rate. Medical aids then pay at that rate, with some plans paying 2 or 3 times that rate.
If you use private providers, they charge private rates. This can be 5 times higher than the medical aid rates. You can have a significant shortfall with these claims!
What can you do to narrow this claims gap?
Use providers linked to your medical aid as they charge what the plan pays OR, buy a Top up/ Gap cover plan. This helps you meet in-hospital claim shortfalls. This is really the best option.
There are also procedure co-payments like diagnostic scopes and specialised dentistry. These will be taken from your savings (if you have any at the time) or you will have to pay them. The Top Up will pay any scheme related co-payments for you.
A medical aid does not guarantee that you won't have to pay money towards medical costs!
You really need to cover possible in-hospital shortfalls and co-payments as these can be substantial.
Some question you should answer.....
A 20 year old who hasn’t seen a doctor since birth needs something quite different from the 50 year old with high blood pressure and diabetes!
The medical aid must be financially stable. Check their claims paying ability and solvency level.
Remember, the more members - the better the scheme! So choose from larger medical aids.
We only offer plans from the top 5 schemes.
Don’t choose a plan purely on cost. Identify what it is you need, then look for plans tqat best meet those needs. Be realistic about the state of your health and don’t bank on the invincibility of youth, or your current state of good health lasting forever.
Then compare costs and trim your plan to your budget. You must get quotes before joining a scheme and this is not always an easy or understandable process! We try to make this as easy and simple as possible. USE US!
I do not charge and additional fee! You pay the same as if going direct, but I have years of experience in this field. You run a real risk “cutting out the middleman!” Especially where it costs you nothing extra!
No matter what plan you are on, you need to know about exclusions, limits and implications of the scheme’s network of doctors. We provide the information – all you need to do is READ IT!
It is in writing, so there is no misunderstanding. And you can see that discussion ….anytime!
We are just an email away. We will respond far more quickly than getting a broker appointment.
Avoid Hospital Cash Plans. They are insurance products, not bound by the same rules medical aid schemes have to meet. They pay fixed cash benefits and can be extremely restrictive when claiming - very unlikely to meet more than a small fraction of your actual costs.
Buy an in-hospital only medical aid because, claims are determined according to the actual healthcare expenses you face and not on a pre-agreed, daily cash sum. Far more secure.
Don’t be drawn in with wellness and loyalty programmes. They are not the reason you are buying a medical aid and you pay to belong to the programme. To get reasonable rewards costs money. A free rewards programme is worth what you pay for it!
However, some wellness plans are worth it, if you are dedicated enough to use them properly. Again, talk to me for help in making a decision.
If you do your research properly and get professional help, you can choose a plan to best suit your needs. Then you won’t be disappointed when claiming, because your expectations will be met.
You may think that you’ll never need medical cover, but considering that one episode in a private hospital can set you back hundreds of thousands of rand, is it not better to pay a small monthly contribution to ensure you are covered?
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