As mentioned earlier in the series, medical aid is a health insurance product that covers the costs related to healthcare.
The product provides protection against the hefty bills that occur after medical procedures as well as your day-to-day medical expenses. Before jumping the gun and taking out medical aid, it is important to recognize the importance and advantages of it.
Understanding medical schemes and their plans allows you to choose the correct option.
How do Medical Schemes work?
A medical scheme (or medical aid) provider is a company that provides its members access to private healthcare services. It can be seen as a community fund which consists of different individuals with different healthcare needs all contributing towards a common goal – quality healthcare services.
There are different types of medical schemes out there, some open to the public and some which are only available to certain eligible groups.
The ‘restricted’ schemes are only available to people that fall into a particular profession, association or qualification class.
Open / “public” schemes are open to everyone and no one can be denied a chance to join an open medical aid scheme.
Upon joining a medical scheme, you can choose your preferred plan depending on your needs and affordability.
Medical Schemes have set premiums for certain plans and this is regardless of your age or health. Medical Schemes also offer Capitation Options which are linked to income brackets and can be more expensive for members earning more than R13801 per month.
On joining a medical aid you could have a 3 month general waiting period and/or a 12 month pre-existing condition exclusion.
Each member’s situation is unique and for this reason it would be advisable to speak to a financial advisor, so that you can get the plan best suited for your family’s needs.
Why is having Medical Aid important?
Medical aid is an effective way for you to cover yourself financially should you or your family need medical attention or supplies. Healthcare procedures and medication can get extremely expensive when they occur on a regular basis or if they occur unexpectedly.
Did you know that if your precious bundle of joy arrives unexpectedly early and needs to go to the NICU, it is over R12000 per night! Excluding doctors, medicine or anything else they may need… Imagine an unexpected stay of a few weeks… would your savings cover it? You are basically looking at well over R100k just because your birth plans didn’t quite go as expected.
Having medical aid cover in place provides protection against these financial burdens that can eat into your living expenses as well as emergency funds (and sometimes require even more than that). Medical aid also provides access to the benefits of private healthcare specialists and amenities. This adds to your overall state of health and cuts out the need of going to a public hospital which isn’t always a good experience.
What are the Advantages of Medical Aid?
There are many advantages to having medical aid!
- It provides you with financial protection in the event of having to pay large medical bills
- Medical aid provides cover for prescribed minimum benefits which include 271 medical conditions (see full list here)
- Medical aid provides cover for 26 chronic conditions regardless of the plan you are on (see full list here)
- Medical surgeries and treatment costs get paid timeously relieving you of the stress around having to save up for these events
- Medical aid allows you to go to private hospitals and doctors instead of having to go to sometimes inefficient and overcrowded public hospitals
- The government offers you the chance to save on your tax payable by joining a medical aid (Medical Tax Rebates)
What are the most common Medical Aid plans?
When joining a medical aid scheme, there are multiple membership options available depending on your needs and affordability:
Comprehensive Plans
These plans offer comprehensive cover of hospitalization at private healthcare facilities. These plans also cover a range of day-to-day benefits which include specialist visits and chronic medication expenses.
Hospital Plans
These plans only cover you for in-hospital procedures together with cover for 26 chronic conditions but does not cover any day-to-day benefits such as GP visits.
Savings Account Plans
These plans cover various expenses such hospital emergencies, major medical events and prescribed minimum benefits. All the other day-to-day expenses are funded by the members themselves by contributing to their savings account.
Network plans and Capitation Option (income-based plans)
Members on these plans are restricted with regards to the hospitals that they can go to. These plans also offer some day-to-day cover but again at a doctor in a particular network. Members lose the ability to choose where they want to go but these plans are more affordable because of the limitations that the scheme provides regarding doctors and hospitals.
Having the best suited medical aid cover in place doesn’t necessarily mean the most expensive plan – it means having the right plan for your family’s needs.
Why not give us a call so that you can have peace of mind that your family’s healthcare needs are taken care of. Medical aid is definitely not a one size fits all!
Please keep an eye out for our next blog where we will be going into some of the nitty gritty of medical aid, namely later joiner penalties and waiting periods and what those terms actually mean.
All medical aid providers have agreed rates that they will pay towards a procedure or consultation. Most medical aid rates are 100-200%.
This is the difference between what the medical aid has paid towards a service providers account and what you are liable for. Some doctors charge way more than medical aid rates which can you leave with a very big shortfall. This is where Gap cover can be very helpful.
When you join a medical aid, you will get a 3-month general waiting period. This mean that you will not have access to any of your medical aid benefit within the first 3 months of membership.
Important to note that the prescribed minimum benefits and emergencies are still covered. The waiting period is really only to prevent new members from signing up because they are ill. It would not be fair to along people to only sign up when they need it as other members would be covering their medical expenses.
