Access to good healthcare is a concern for most South Africans. However, choosing a medical aid to suit your financial status and needs can be very confusing. Find out how it works now. Gerhard Van Emmenis, Principal Officer of Bonitas Medical Fund, provides some pointers to make the decision easier.
1. Medical options are many. There are 83 medical aids operating in South Africa, according to the Council for Medical Schemes. In addition, the implementation of NHI looms. With all the plans offered by medical schemes, making a choice is daunting.
2. Know what you and your family need. This is both in terms of cover and what suits you best. Look at your family’s health history and determine the number of visits you make to the doctor and the cost of medicine. Consider whether anyone in your family has a chronic condition or needs to see a specialist. Evaluate how much you spend – or need to spend – on dental or eye care. If you already have a medical aid plan, check what was covered, how much your co-payments (if any) were and whether your savings for the year were adequate.
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3. Your budget. Once you have an idea of what you might need for the year ahead in terms of healthcare, then it’s time to look at your budget. What can you comfortably spend to get the medical cover you need? The rule of thumb is that contributions should not exceed 10% of your monthly income. “Once you have these two scenarios then it’s time to compare the various plans and see which best matches your needs and budget,” says Van Emmenis.
4. Benefits vary per plan. Check what the plan you are considering covers. Look at whether the plan offers benefits in addition to your savings. These benefits help your savings last longer and give you more value for money. Examples include wellness screenings, flu vaccines, mammograms and pap smears. Remember, in terms of the Medical Schemes Act, there are 26 common chronic illnesses, known as Prescribed Minimum Benefits (PMBs), which all options on all schemes are required to cover.
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5. Day-to-day benefits are one of the most misunderstood elements of medical aid. “Medical savings are a fixed amount that the medical scheme gives you at the beginning of the year,” explains Van Emmenis. “You can use your savings for daily out-of-hospital medical expenses, such as GP and specialist consultations and over-the-counter medicine. It is imperative that members use their savings and day-to-day benefits wisely to get maximum value for money.”
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