With no medical scheme cover – or at the very least a hospital only plan - you will be in serious trouble! Medical cover is probably the most important safety net you can buy for yourself and your family. Joining a medical plan must be your priority!
You can have a car accident the very 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?
Waiting periods can be imposed on a new members, the length of which depends 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 and healthy to join!
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 this runs out 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 have extended the cover that is paid from risk not your day-to-day savings, thus extending the life of your savings!
For example, emergency room trauma like a broken leg or stitches, arel paid claims 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!
If anyone in your immediate or extended family (grandparents, parents, uncles, aunts, or siblings) suffers from hereditary chronic diseases - like high blood pressure, high cholesterol or diabetes - you need to plan for that happening to you.Your out of hospital and chronic medicine costs may well dictate that you look at a comprehensive plan.
If you have existing or are expecting future health issues – that are NOT PMB conditions - then a comprehensive plan may be what you need, as these plans offer both in and out of hospital cover.
If the answer to this question is a resounding NO – then why not consider a hospital only plan and pay your own day-to-day costs?
It will certainly be way more affordable, whilst protection you against the real threat of not having a medical aid - hospitalisation!
Hospital cover - You want unlimited private hospitalisation (maybe with a few sub-limits for some treatments) and guaranteed hospital admission with emergency cover.
You want to make sure th at major surgeries and medical treatments in hospital are covered.
These plans are specifically designed to cover the major portion of all treatment and accommodation costs that may arise during hospitalisation in a private clinic or hospital.Some treatments require an upfront payment, (for example back surgery, gastroscopies, laparoscopies, removal of wisdom teeth, colonoscopies and joint replacements), however you are covered for major medical emergencies and hospitalisation.
Day-to-day (out of hospital cover)Treatments like doctors, dentists, and over the counter medication. These costs are generally paid from a savings account you have in the medical aid. As long as there are funds in the account, you can pay bills.
Once the funds are used, some plans pay further, limited, benefits (like network GP consultations or medicines).
Other plans offer a safety net where, once your claims add up to a defined amount, they then pay further costs (sometimes with a co-payment from you) for the rest of that year.
But, these are expensive plans!
Day -to-day benefits is an area where you may be able to “save“ on your medical aid.
We have never experienced anyone going bankrupt over a GP,chemist, dentist or optician’s bill, so the risk of self-funding these expenses should be low.
Maybe you should consider a hospital ONLY plan and pay your day-to-day costs yourself?
Medical cover is an insurance, that covers you for large and unexpected events which could financially wipe you out, not a way to buy chemist supplements and occasional GP visits!
You can 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.
You can also invest in a dental plan to help with dental these costs. They will probably be your highest day-to-day expense going forward.
Chronic medicines. All medical aid plans have to offer cover for 26 PMB conditions. If you have a non-PMB chronic condition, you may need to look at a plan with higher chronic benefits. All plans have lists of medicines they provide.
Again, you may need a higher benefit plan if you have a need for a specific chronic medicine.
We can help you with these concerns.
You also have to make sure how the scheme and option cover oncology, dialysis and HIV. Most schemes have specific benefit programmes for these conditions, which offer good cover, but it is important to make sure exactly what that cover is.
They are recommended for families with small children and high needs for doctor or dentist visits. Offering comprehensive cover for emergencies at selected private hospitals, they generally do not cover hospital admissions for more elective procedures such as, for example, elective caesarean, specialised dental and nasal surgery. The premiums are based on income, so those earning less get to enjoy the same benefits as those with higher salaries. Premiums start from a little as R370 pm for as single member.
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