There are so many schemes and plans option available, so much technical wording and a lot of confusing information available,
that you must use an Independant Medical Scheme Broker!
And I can help you AT NO COST!
Most schemes offer members the option to move to a lower plan during the year and many are considering options that:
Whatever you do, never be without private healthcare hospital cover!
If you are on a tight budget, you may have no option, but to reduce your contribution.
However, please try to consider other areas of cost saving before you consider changing your medical scheme.
Most important of all - get professional advice before doing anything!
If you can self-pay normal day-to-day medical expenses, such as GP visits, consider an in-hospital benefit only plan.
It is far more affordable than a comprehensive healthcare plan, whilst covering your greatest risk of high medical costs!
You must cover private hospitalisation. for without it you are in trouble having to use state care!
Next highest cost, is dentistry, both in and out of hospital.
Most members can afford occasional dental bills, but wisdom teeth removal or implants can be extremely expensive so, consider a Dental Insurance Plan, to help pay for unexpected costs.
By insuring for these two areas of high risk and self-funding the balance of your day-to-day costs, you will have an affordable plan that gives you security that unexpected high costs will not bankrupt you!
Some schemes also offer:
Many happy medical scheme members have only in-hospital benefit plans, as they feel secure in knowing they are protected from unexpected, high medical costs.
All schemes offer plans that cover in-hospital costs only, but some have very attractive advantages!
Contact me and I can show you ideas!
Join this plan and you address your 2 greatest medical expense risks - private hospital and dental costs - AND can use any provider you want - all in one plan!
Not only that, but it has had the lowest rate increase of any hospital plan over the last 8-years!
Cover for additional members and children is very affordable, making this plan an excellent option for young families, low-income individuals, retirees, or people in good health who only need private hospital and dental cover and can comfortably pay their day-to-day expenses!!
That's good news! Check it as you will not be disappointed!
It is your money as you paid for it as part of your monthly contribution.
Surely you could do better investing your own savings. Of course you can!
Self-funding out of hospital costs, is really the same as a medical aid savings fund. The only difference is that a medical scheme will give you credit for the year - up front in your savings -whilst your own savings take time to grow.
BUT, at least this money is yours and you can do what you want with it!
Why not create a savings plan in a bank account, or use your home bond as an access account!
I personally, added extra to my home access bond! In this way, I lowered the capital loan of my bond, saving a huge amount of interest, which far outweighs any return I get with a medical scheme savings account!
And I have access to a large savings fund, should I need it!
Now, you will have unlimited private hospital cover, paying up to 500% of the medical scheme rates, with essential dentistry benefits and no network providers!
Unbeatable benefits and cost!
A savings fund can be a great help when you have high out of hospital medical expenses and do not have the cash flow to meet them. It will allow you to get immediate medical treatment and medicines, speeding up your recovery.
The savings account is a fund of your own money, created from an amount added to your contribution. The Medical Schemes Act, allows you to save up to 25% of your risk premium in a savings account.
(Note that if you accumulate a credit savings balance, you cannot withdraw the cash.
You can only access it when you terminate membership and as long as you don't join another plan with savings option - as the funds are transferred.)
If you can minimise the amount of the savings fund you feel you need - you could drop your contribution by that savings portion of your total premium!
A few schemes do offer plans with different savings contributions to meet member preferences.
With prudent savings management, your premium can be significantly lower than other schemes!
flexiFED plans give you more control, flexibility and choice over your medical plan. And they costs less!
They offer in private hospital cover, chronic condition benefits and a unique method of using savings for day-to-day costs.
Now, for the first time ever, FlexiFED allows you to begin paying for day-to-day benefits only when you use them - not before!
Here’s how you save… normally medical aid members are charged for day-to-day savings from the beginning, regardless of whether you have used your savings or not! It is like a compulsory loan being repaid as part of your monthly premium!
But, with these plans, your contribution will be lower, until you use your savings, as only then do you begin to pay those used monies back - interest-free.
Yes, the longer you delay using the savings account - the longer you experience lower premiums!
There are plans that have a safety net benefit, should you have high out of hospital costs and have used up your savings.
The plan will pay certain further costs for that year.
However, these plans are very expensive and you need to carefully investigate your situation to see if you really need that threshold benefit.
Most members only reach their threshold benefits late in the year, so they do not use the benefit fully - yet have paid for it!
It may well be that the cost of a threshold benefit is higher than the actual expenses you pay and it would be cheaper to pay those costs (after your savings are used) yourself?
The flexiFED plan (discussed above) is ideal for this type of medical aid plan!
This type of plan will cover your hospital and chronic needs and is suitable for people who are in good overall health, but do incur occasional medical expenses out of hospital.
Schemes also bundle maternity benefits into these plans, making them an affordable option for young mothers-to-be.
Or, how about a plan that offers unlimited network private hospital cover, guaranteed full cover for network in-hospital specialists, chronic medicine, unlimited network GP consultations, a list of defined acute medicines, a dental check and an eye test – all with a small co-payment when you need to use them?
And it offers specific sports-related injury benefits!
You only co-pay for certain out of hospital costs when you need them, not as part of a monthly contribution, therefore avoiding having to pay for savings that you don't really need!
Something you must consider - when considering only a hospital only plan - is a GAP or TOP UP plan.
At the beginning of a year, all medical providers and medical schemes decide on the cost of a procedure. That is known as the scheme (medical aid) rate. Schemes then pay at that rate.
If you use private providers, they can charge what they want - known as the private rate. This can be 5 times more expensive than the medical scheme rate!
Medical schemes now offer more expensive plans that pay up to 3 times their scheme rate but, these more expensive and can still leave you with a claim shortfall.
Schemes are also increasingly adding co-payments for certain in-hospital procedures. Again, more expensive plans have fewer co-payments.
What can you do to address these threats?
If you use network providers, they charge what the plan pays, so you should never experience an in-hospital claim shortfall.
Or better, buy a Top Up/Gap plan that will pay any in-hospital shortfall and co-payment.
You can now consider a lower cost plan paying scheme rates (not the more expensive 2 or 3 times scheme rate), because you are protected against shortfalls from high in-hospital costs!
Every member should have an insurance-based Top Up plan.
It is a vital part of having a full in-hospital benefit, healthcare plan!
And the scheme may continue paying GP costs, even if your savings have been depleted!
Medical schemes offer these preferred provider network plans at a lower cost and can help you investigate them.
If the providers are acceptable, then joining these plans is your answer!
Choosing a hospital plan that uses networks brings your medical aid costs down even further, because the medical aid has negotiated tariffs with those providers and they pass that discount onto you as a lower premium!
Take a look at Momentum Health Medical Aid
Are you on regular medication to treat a chronic illness?
Medical schemes have to cover the costs related to the diagnosis, treatment and care of an emergency medical condition, a defined list of 270 diagnoses and a defined list of 27 chronic conditions.
Maybe you qualify for chronic medication benefits, where the scheme pays costs - without using your savings?
Ask your doctor to motivate for this and by completing a simple form, you could save yourself hundreds of rand a month!
Here is a medical scheme that offers lower rates depending upon where you source your chronic medicines.
Contributions differ if you get your medicine from any chemist, a network supplier or the state.
If you do not need chronic medicine, these are the plans for you!
Your medical aid only pays for authorised chronic medication up to a certain level of cover and higher-priced medicines will use up your cover much faster.
Consider using generic equivalent medicines as you can save up to 30% of the cost of these medicines and extend your benefits!
Most medical schemes offer network provider plans and if you are happy with the networks, you can get good benefits for a reasonable cost!
Some network plan contributions are based upon your income and are the lowest cost medical scheme plans available. However, they can be restrictive in the benefits they offer, but do offer life-threatening and life-sustaining benefits for extremely affordable premiums!
They are an ideal medical aid for pensioners, children who become adult dependants, students and those who earn low-incomes, but want access to private healthcare.
INGWE Medical Aid - offers an ANY hospital option as well!
KEYCARE Medical Aid - the most popular and largest plan in South Africa!
There are plans specifically designed for full-time students, offering excellent benefits at a really good price!
Moving students onto their own plan, which you can pay for, is first prize in reducing your overall cost!
Although they have cheap premiums, they don’t compromise on quality of cover!
Your child’s healthcare needs are covered but, at a much more affordable rate.
You do need to submit proof of full time study and a parent can pay the contribution.
A child aged 21 can no longer be listed as a child dependant on your scheme with most schemes.
This means that their contribution will increase substantially or even double!
Some schemes do offer child rate cover - for financially dependant children up to age 27, as long as they are unmarried and not earning more than the maximum social pension.
Is your child studying part-time, but earning an income?
Then s/he will become an adult dependant on your plan at an increased cost.
(Any income precludes them from joining a student plan.)
Why not consider that they join their own income-related Network Plans (above), as the rate should be very competitive.
You can pay the contribution if needs be.
They allow access to private providers, have unlimited hospitalisation and mostly unlimited basic day-to-day benefits.
Is your child is working full-time, but earning an entry-level salary?
Again, consider the income-related plans (above) or investigate more affordable medical aid cover such as hospital plans with gap cover.
The premiums on these plans are lower than comprehensive plans, but they still cover the most important medical needs.
With both these plans, even if you keep on paying your child’s contribution, you should still end up saving hundreds each month!
Given that the elderly are more prone to chronic conditions and other age-related illnesses, healthcare can become very expensive.
Prescribed minimum benefits - conditions such as high blood pressure, type 2 diabetes or cholesterol become problems as we age. These conditions often require expensive, ongoing medication.
The government has legislated for prescribed minimum benefits (PMBs). This is a list of 270 conditions which, by law, even the most basic of medical schemes have to cover.
Regardless of what form of medical cover you and your parents choose, at least their chronic medication is paid for.
Or, make them a dependant on your plan. If you can prove dependency on you or your partner, they can join your plan.
However, if this is the first time your parents are joining a medical plan, or they have a long break in membership, they will be subject to a late-joiner fee, which will increase your cost.
They may also face waiting periods.
They have their own medical plan. If they are not earning high incomes, look at the income-related plans (above). The only concern may be access to network providers?
Again, you can pay the contribution.
They can also cover hospitalisation and dental care through the Best, Affordable Hospital Plan with Dental benefits!
This plan covers the 2 highest risk areas of their healthcare needs as they age. It will cover all in-hospital care, as well as PMBs.
Please AVOID Hospital cash-back plans! They are insurance-based products and do not have to cover all the things a medical aid does. Cover can be restrictive and claims difficult to get paid.
The reality is many of us are going to have to contribute to our parents’ upkeep, so it’s worthwhile looking into medical scheme options, before it gets to the point where they really need it and your choices become extremely limited and premiums are excessive.
I can resolve these concerns for you at no charge!
Yes, you pay what you are currently paying – nothing more.
I do need to be appointed as your broker, as this gives me and my team access to your problems.
In a couple of days, I will confirm acceptance and we can quickly get onto your concerns.
Medical aid is a complicated product. We do need to have it, but we must fully understand what the benefits and limits are.
This is where we can help! We know these products... all the fine print.
And we can show you what cover you have!
I am a fully licenced and accredited broker with over 30-years of experience.
Do you experience unnecessary stress at year-end when the time comes to select your plan for the following year?
This is when you need help!
We work with medical schemes all day. I know the in's and out's of a good plan and can readily show you options to suit both your needs and pockets.
It is NOT always ideal to change medical plan.
You can get waiting periods joining a new scheme.
Rather investigate moving to a different plan, within your current scheme
TALK TO ME .... I am here to help you - AT NO CHARGE!
Send me your questions and concerns. I'll answer them for you.
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You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.
Medical aid pays healthcare costs.
What if a disability STOPS your income?
Last update: May 6, 2021
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Last update: May 6, 2021
Medical Aid Authority Peter Pyburn.
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