It’s THAT time of the year - when medical aid schemes are hoping to attract new members.
Traditionally the schemes launch their new product plans and announce the revised benefits and premium contributions in September and October.
While it may be an information overload, knowledge is definitely power when choosing the right scheme and cover option for you and your loved ones.
With at least 80 medical schemes in South Africa, choosing the right one can be a mammoth task and a very confusing one.
So we spoke to a few experts in the game on the things to keep in mind when making a decision.
Mark Arnold, principal officer of Resolution Health says: “People who are joining a medical scheme for the first time and are not certain what their chosen benefit option entitles them to, are at risk of either not making full use of their benefits or discovering that they do not have adequate cover for their healthcare needs when they need it most.”
A fundamental aspect in understanding how medical schemes work is that, by law, schemes must operate as not-for-profit entities.
Arnold adds by law, open enrolment schemes are obliged to accept all persons who apply for membership.
Gerhard van Emmenis, Bonitas principal officer, said diligence and homework was required ahead of choosing medical aid.
"The most important factor is to know what you and your family need in terms of cover:
Reflect on your family’s health history to gauge the number of visits you make to the doctor and the cost of medication.
Whether anyone has a chronic condition or needs to see a specialist.
How much you spend on dental or eye care.
If you already have a medical plan, check what was covered, how much your co-payments (if any) were and whether your savings for the year were adequate.
"Once you have an idea of what you might need for the year ahead, then it’s time to look at your budget. What can you comfortably afford?
"The rule of thumb is 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,” Van Emmenis said.
The Board of Healthcare Funders of SA cautions members to be careful:
If you change schemes, you might suddenly find yourself having to pay adult rates for your child who is studying at university.
Or, if the specialist you’ve been seeing for the last 10 years is not on the new scheme’s list and you want to continue using the doctor, you may have to pay for this yourself, especially if he or she charges more than your benefit tariff.
Never assume that the benefits under the new scheme may be the same as your current medical aid.
Some schemes allow you to keep your student children registered as dependants up to the age of 25 while others cut-off at 21 or 23.
Some medical aids restrict the number of specialist visits in a year while others restrict which specialists you can use by means of a list of designated providers or participating providers.
“Make sure the benefits of the new scheme are a good match for the health conditions you and your family experience,” the board advises.