A medical aid gives you the ability to choose a convenient hospital, when you need one. You have NO CHOICE in a government hospital and often they are far from home and an inconvenience for you and your family.
Government ambulance services are slow compared to private services and a good medical aid will get you to a hospital quickly.
If you have an accident or illness in a remote area, a private service will get you to a hospital quickly even if you are in some distance away from an ambulance service.
A medical scheme will protect you and your family financially, should you suddenly have to pay for high medical costs. You do not know what your health may like be tomorrow!
It will also prevent you having experience long delays in your medical treatment. Time that can be life saving.
If you are diagnosed with an illness or condition (and pregnancy is a condition!) a medical aid will place a waiting period on treatment for that condition. So the sooner you join - the better!
With a good medical aid you will have a choice of convenient hospitals if you have to be admitted. Many times, with government hospitals, you have to go where there is space available.
This could be far from home and an inconvenience for you and your loved ones.
Without medical aid – or at the very least a hospital only plan - you will be in serious trouble!
Medical cover is the most important safety net you can buy for yourself and your family.
The importance of belonging to a medical aid cannot be undersetimated! Joining a medical plan must be your priority!
You insure your car, house and aother personal things - DON'T IGNORE YOUR HEALTH COSTS! They can be way more expensive than a damaged vehicle!
If you are healthy then consider a hospital only plan and pay your own day-to-day costs.
They are more affordable, whilst protecting you against the real threat of not having a medical aid - hospitalisation!
Some even pay out of hospital dental costs along with Private hospitalisation!
Medical aid is an insurance that covers you for large and unexpected events which could financially ruin you.
It allows you to access the best treatment when you do need it and that cannot be under estimated!
There are 2 forms of medical cover: Comprehensive medical scheme cover that pays hospital and day-to-day and chronic medicine costs, or Hospital plan that will pay in-hospital expenses and chronic medicines only. You pay all out of hospital expenses like GP, dentist, chemist and optical yourself.
Your medical scheme pays claims out of either: the scheme itself - risk cover – usually for major events. This is the insurance portion of the scheme or day-to-day savings – for doctor’s visits, blood tests and medication. When these are spent, you no longer have cover for day-to-day expenses, except on the higher plans which offer a safety net when savings are used.
What a medical scheme pays for from risk versus savings is an important issue.
Some schemes extend the cover that is paid from risk and not your day-to-day savings, thus extending the life of your savings!
For example, emergency room trauma like a broken leg or stitches, are paid, without using your day-to-day savings account.
Some medical aids have extended this trauma benefit further, where ongoing physiotherapy is paid.
They also pay for MRIs and pregnancy scans from the scheme and not your savings!
SOME PAY DENTAL COSTS, WITHOUT USING YOUR SAVINGS, extending the buying power of your money!
There is a medical aid that offers a unique day-to-day savings option, where you only start paying for savings once you use them! Most schemes charge you for savings from the start - whether you use them or not!
Why not provide your own day-to-day savings fund...open a bank savings account, or use your home as an access bond – pay extra into it and use that for day-to-day expenses.
We also sell a HealthCard – a dedicated debit card that can only be used for your medical expenses. An ideal way to fund for your day-to-day expenses.
Chronic medicines have to be paid for 26 PMB chronic conditions.
All plans have lists of medicines they provide. If you have chronic need, outside of these PMB conditions, you may need to look at a plan with higher chronic benefits.
We can help you with these concerns.
Most medical schemes have specific benefit programmes for oncology, dialysis and HIV. It is important to make sure exactly what that cover is.
Preventative care benefits. Medical schemes offer a range of preventative care benefits in order for you to remain healthy. Beeits such as ‘flu injections, mammograms and prostate screenings, all paid for by the scheme.
You use network providers, but can get a range of benefits such as GP, dental and screening benefits paid.
Investigate the value of the preventative care benefits, as these will aid in preventing more serious conditions developing in years to come.
2. 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.
3. 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 with plans that have an 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. Some plans require a co-payment as well.
4. 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 belong to a medical plan. Ideal, affordable plan for pensioners and families on a strict budget!
You can have a car accident the next time you travel! You can suffer a survivable heart attack whilst reading this!
How much do you think 6-weeks in intensive care will cost?
Do you have that money to spend?When joining any open medical scheme in South Africa, the medical scheme has the right (in reference to the Medical Schemes Act of South Africa No. 131 of 1998) to implement underwriting on any member joining that scheme. To find a medical aid with no waiting period is very unlikely.
Waiting periods can be imposed on a new members, the length of which depends upon your health and how long you’ve been without medical aid cover.
They can range from a 3-month general waiting period to a 12-month condition-specific waiting period.
There are also Monthly Late Joiner Penalties to consider. The older you are when joining a medical scheme, the more severe the late joiner penalty. The penalty depends on how many past years of medical aid membership you have.
So, the sooner you join a medical scheme, the lower any possible penalty will be. You can never be too young or too healthy to join a scheme!
What cover do you need?
The greater your benefits - the higher the premium! So it is vital you have an idea of what you want from a medical plan. If you are happy to get a plan that does not have all the "bells and whistles" (say a hospital only plan), you can save considerable money!
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. But, 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. Schemes also now offer the use of listed providers, in which case your costs are paid in full.
However, there is always a threat of a shortfall with claims. And many schemes are also introducing co-payments for certain in hospital procedures.
You are strongly advised to consider a GAP or TOP UP insurance plan to address this threat.
IN YOUR 20'S: CONSIDER A HOSPITAL ONLY 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 want 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 with your plan.
IN YOUR 30’S: LOOK AT AFFORDABLE COVER FOR A FAMILY.
With children, you need a more comprehensive plan - hospital, GP, chemist, dentist and optical benefits. But, these are expensive plans, so consider a cheaper option that uses network providers. Prevention is better than cure, so you need regular dental, cholesterol, glucose and blood pressure tests.
Pregnancy is expensive! Your plan must cover you throughout pregnancy and birth. Consider a more comprehensive option before you plan to start a family. Medical schemes will not cover pregnancy if you have already conceived.
IN YOUR 40S, 50'S AND OLDER: THE MORE COVER THE BETTER.
You have 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.
You may feel you don't need medical aid but, to not have - at least hospital cover - is like driving a car with no spare tyre. A high risk!
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!
I WANT A QUOTE
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?
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!
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.
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!
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 INDEPENDENT MEDICAL SCHEME ADVISER!
I can help you AND I CHARGE NOTHING FOR THAT SERVICE!
Here are some ideas to consider that may help you keep your medical aid:
Your biggest financial risk is the cost of private hospitalisation. You cannot compromise on this!
Next highest expense is normally in and out of hospital dentistry. Again effective cover is a must!
Lastly doctor, chemist and glasses, which you may be able to self-fund through your own savings plan.
Your answer is to consider joining a lower benefit and cheaper plan.The greater the benefits of a plan, the higher the costs.
So, consider cheaper options that have smaller medical savings plan or no savings plan at all.
Whatever you may do, never be without hospital cover!
All medical schemes offer plans that cover in-hospital costs only.
There is a plan that offers unlimited in-hospital cover AND cover for certain out-of-hospital dental benefits!
This plan addresses both the major cost threats we face – all in one plan. It is unbeatable!
You may also be on a plan that offers a safety net, should you use up your savings. These plans are very expensive and here you need to investigate carefully to see if you really are using that threshold benefit.
It may well be that the cost of that benefit is higher than the actual costs it covers and it would be cheaper to pay those costs (after your savings are used) yourself?
Coupled with your Top Up plan, you could look at a plan that pays in-hospital costs at medical aid rates and has a small savings.
At least you have cover for those unexpected costs, whilst managing your normal day-to-day costs yourself.
Of all day-to-day costs, dentistry is generally the most expensive. So if you are expecting dental treatments, be sure you save a sufficient amount each month.
OR look to the only scheme we know that pays dental benefits as well!
You may also have elderly parents on your medical aid. Again, it would be more than worth your while to investigate moving them to an income-related network plan. This could have a significant overall premium saving for your family.
So you can see there are a number of ideas to help you control your medical aid premium. But the best advice is talk to a broker.
Let us investigate and present the various options open to you.
Medical aids pay us for helping you. You will pay the same premiums if you use a broker or not.
So, it makes sense then to get advice and help from me and my team who fully understand medical schemes.
We have a dedicated team within the medical aids and we promote the best medical aids in South Africa:
Appoint us as your medical aid broker at no extra cost and you can use both us and the team to get your concerns sorted!
Please complete and return the MEDICAL APPOINTMENT form to us.
Once appointed, we will be able to investigate your concerns and help you get them fixed.
USE US - YOU HAVE NOTHING TO LOOSE!!
If you use private providers, they can charge what they want - known as the private rate. This can be up to 500% or 5 times more expensive than the medical aid rate!
To help you meet these high costs medical aids now offer plans, that will pay up to 3 times their scheme rate, but these are still not good enough!
In addition, they are increasingly adding co-payments for certain in hospital procedures. More expensive plans have fewer co-payments.
What can you do to address this threat?
If you can use providers who are have a payment agreement with a medical scheme, they will charge what the plan pays. So, you should never experience an in-hospital claim shortfall.
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