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7 ways to maximise your medical aid benefits

Emergency care and treatment are Prescribed Minimum Benefits under the Medical Schemes Act. All medical plans are required to cover the entire cost of these benefits. Picture from Pexels

Emergency care and treatment are Prescribed Minimum Benefits under the Medical Schemes Act. All medical plans are required to cover the entire cost of these benefits. Picture from Pexels

Published Oct 18, 2023


Because healthcare expenses seem to be rising constantly and South Africans feel permanently pressed for cash, it's important to maximise all of your medical aid benefits.

Aim to minimise out-of-pocket costs and ensure you receive the care you are entitled to, regardless of whether you have comprehensive insurance or are on a hospital plan.

Make sure you read and comprehend the terms and conditions of any medical assistance programme before you legally sign a contract with them.

Although the medical aid sector is known for utilising technical language and jargon, it's imperative that you understand exactly what is and isn't covered right away.

This will provide you the tools to compare prices and find the best "bang for your buck".

In addition, it will guarantee that you receive the benefits to which you are legally entitled as soon as you join a scheme.

Re-evaluating your healthcare risks once a year is a smart idea. An inexpensive option if you're young, single, and in good health is a hospital plan.

Your healthcare needs usually change when you become a parent and then again as you become older.

It is advised that you gradually increase the amount of medical insurance you have.

At first, you could choose to go from a hospital-only plan to one that includes daily savings.

As you become older and closer to retirement, having more ongoing coverage becomes crucial. Your best option at this point is thorough medical aid.

To optimise your medical aid benefits, follow these tips from Jeremy Yatt, Principal Officer of Fedhealth.

If you're using a network option, be sure to use network providers

Many medical plans provide network options at a discounted monthly charge so that members can be assured of a certain pricing.

Hospitals, physicians, and other providers could be a part of these networks. Try to use the providers that are listed if you're on a network option to save money on needless co-payments.

Take advantage of the screenings and preventative care that your medical aid covers

Prevention is preferable to treatment. Early diagnosis can potentially save your life and save you hundreds of thousands of rands in the long run.

A screening benefit that includes things like the HPV vaccine, mammograms, and health risk assessments is typically included in medical plans.

Recognise the scope of your coverage and make a commitment to regular check-ups.

Make use of any programmes or value-added services your scheme offers

Numerous courses and services are available to members of these schemes; some examples include weight control, smoking cessation, and even free medical helplines.

Ascertain the provisions of your plan and ensure that you fully take use of these complimentary services.

Avoid paying extra for medication that is prescribed

In addition to filling prescriptions exclusively through the plan's approved pharmacy provider to avoid co-payments, keep in mind that generic drugs have the same ingredients as brand-name drugs but are less expensive, so request these whenever you can.

According to Yatt, many people review their medical insurance at the end of the year, which is generally medical aid renewal season.

The following are some situations that could lead to a plan modification:

You might need to think about downsizing if your financial circumstances have changed, such as if you've lost a sizable portion of your income or your employment.

Keep in mind that a less expensive medical assistance plan translates into less benefits, so be sure the plan you choose meets your needs for healthcare.

On the other hand, if things have been better financially over the previous year and are expected to stay that way, you might want to think about upgrading your coverage for extra assurance.

If you intend to have a child

Given the high cost of maternity care, it is advisable to start your pregnancy with a reliable medical assistance plan that offers comprehensive maternity coverage.

Take into mind that there is often a 12-month waiting time after joining a medical assistance plan if you are not already a member before you can receive benefits like pregnancy assistance.

A shift in your overall health

If you receive a diagnosis of a chronic sickness or a life-altering disease, such as cancer, it could be a good idea to switch to a medical aid plan with stronger coverage to help you manage your particular condition.

The age of your dependents

Children who are in school or who are young, employed adults are frequently maintained as dependents on their parents' health insurance coverage.

Yatt comes to the conclusion that when things are tight financially, it's a good idea to look for clever ways to minimise expenses and maximise advantages by being well informed about your medical options.