Medical aid and severe illness cover – the ultimate dream team protecting you and your loved ones
October and November mark breast cancer and prostate cancer awareness month respectively, shedding light on the importance of awareness and early detection in the successful treatment of these severe illnesses. Although only two types of cancer are highlighted specifically during these two months, there is an entire spectrum of dread diseases that can rake havoc on our bodies, minds and families. Furthermore, the treatment costs for severe illnesses tend to make an unreplaceable dent in one’s budget and savings, which is why it’s so important to take the necessary precautions.
You may ask, how do you prepare for something like cancer? Truthfully, no one is ever 100% prepared for it. Yet, with CANSA reporting that every year 14 million people will hear the words you have cancer, the likelihood of developing cancer is rising and being prepared for it, especially financially, is becoming more of a necessity than a luxury.
Cornerstone Healthcare Consulting Services and Cornerstone Financial Planning believe that a well-structured medical aid and a bespoke severe illness cover policy is the best way to ensure that you are adequately covered for the financial strain that accompanies a severe illness. Although these two products are completely different in the way they are structured and managed, when used together, they become a dream team that will protect you and your loved ones when you need it most.
How does medical aid cover differ from severe illness cover?
The cover that will be provided by your medical aid is set out by your benefit option guide and the best is to refer to your benefit brochure. However, if the content seems foreign to you, please click here to get in touch with Cornerstone Healthcare Consulting Services and we’ll explain all the tricky intricacies of the medical aid world.
The short answer is that your medical aid will pay a treatment plan specific amounts directly to the healthcare provider or to you (if you’ve paid it from your own pocket first), provided you meet the clinical criteria’s as set out by the medical scheme. Many factors influence the actual pay-out amount including scheme rates, network service providers as well as the option plan you have selected.
Most medical schemes offer preventative benefits like Pap smear, Mammogram, Prostate, etc; to detect early signs of cancer or any severe illness. Members can go for a check-up once or every two ears depending with the medical scheme benefits.
Severe illness cover is a policy benefit that offers protection against illnesses. With a severe illness policy in place, you will receive a tax-free lump sum benefit to aid in payment of additional expenses due to lifestyle changes, possible post illness rehabilitation expenses, assist with shortfalls on your medical aid and to access advanced medical treatment, which is not always covered by your medical aid. The pay-out amount is subject to the severity of the illness as well as the initial insured amount.
Do I need medical aid to get severe illness cover or vice versa?
No. As much as these products work extremely well when combined, you can have the one without the other.
Can I use them together i.e. can they pay out simultaneously?
Yes, you can. Remember, they are completely independent products with different purposes. For example, if you are diagnosed with cancer and you start undergoing treatment, you can claim treatment, medication and other medical costs from your medical aid once your treatment has been approved by the scheme while your severe illness policy will pay out a lump sum that you may do with as you wish.
How does the claim process work for each product?
- Medical aid
Your claim process might differ, depending on the medical scheme and the option plan you have selected, it is also highly dependent on the benefits offer for oncology whether you are on a hospital plan or full comprehensive plan. However, in most cases your medical aid claims process will look something like this:
If you are going to undergo a planned procedure you will have to get pre-authorisation from your medical scheme. You can do this by contacting the medical scheme directly or your intermediary and obtaining the necessary authorisation codes. If there are any shortfalls or co-payments required, GAP cover will be able to help you in covering those shortfalls.
For most small treatments and medications, some service providers can claim directly from your medical aid, whereas others might require an upfront payment which you can claim back from your medical aid.
We would strongly advise that you consider appointing Cornerstone Healthcare Consulting Services as your healthcare intermediary as it will greatly ease this process.
- Severe illness cover
With a severe illness cover policy, the process is slightly simpler. After you have been diagnosed with a qualifying severe illness, you can a submit a claim to your insurer via your broker or financial advisor. Depending on the comprehensiveness of the benefit, the benefit amount, and the success of your claim, a lump sum will be paid out to you in accordance with the severity of the illness. These funds are not paid toward a services provider and it is your money to do with as you see fit. To ensure that you get the highest possible pay-out in the shortest possible time, get Cornerstone Financial Planning on your side. Click here to get in touch with us today to learn more.
No one can predict the future, the best you can do is prepare for most eventualities and ensure that the financial strain is lowered on you and those around you. If you would like to learn more about how severe illness cover and medical aid can help you, click here to contact us today. For more interesting and thought-provoking articles, be sure to subscribe to our newsletter and look for us on Facebook and LinkedIn.