Ten things to consider when choosing a Medical Aid Scheme or Option

– Tanya Motlafe (Director, Cornerstone Healthcare Consulting Services)

Whether you are an existing Medical Aid member or a new member, making sure you have selected the right plan and benefits for you and your family is an important decision to make. Making this decision requires careful consideration and an understanding of all available benefits, as you are generally only able to make this selection once a year.

We, therefore, encourage you to consider the following before making that decision:

1. Choosing a healthcare plan depends on your affordability and healthcare needs. What is your budget and do you understand your current state of health, for your spouse, dependents and for yourself?

2. Is your preferred Medical Scheme financially stable? If you end up in hospital for a major procedure will the scheme be able to carry the costs?

3. Most medical schemes state that you have unlimited cover in-hospital, however, many medical aid members are not aware that this means only being covered up to 100% or 200% of the medical aid rate. How will you provide for in-hospital costs that can be way in excess of medical aid rate?

4. Have you assessed your previous medical aid claims to determine the cover you and your family may need for the forthcoming year?

5. Do you have any chronic conditions and how does your scheme cover both the diagnosis and medication? Is your chronic medication covered from your Medical Savings?

6. Medical Schemes may apply exclusions on certain medical procedures or conditions for a period, or indefinitely. It is important to understand your level of cover and what exclusions are applicable to your plan.

7. Are you comfortable with only using specific hospitals or designated service providers recommended by your Medical Scheme? Is there any benefit in using the network service providers and how do you know which providers are on the network?

8. Are you aware of the rules of your medical aid with regards to the maximum age your child dependent can be covered under your membership? You need to be aware of how this could affect your monthly premiums for that current year.

9. Are you familiar with your healthcare plan option annual limits and annual sub-limits?

10. Does your Medical Scheme offer cover medical emergency costs while you travel outside South Africa, and for how long?

At Cornerstone Healthcare Consulting Services, we assist with Medical Aid Selection, Gap Cover, Medical Insurance and Funeral Cover. We are accredited and licensed by the Financial Services Board and Council for Medical Aid Schemes and we are contracted with all major medical aid schemes. Our recommendations are based on a full needs analysis and not bias to a specific scheme.

Contact us if you need assistance with selecting the right plan and understanding what is relevant when changing schemes or options


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