How to choose the right medical aid option for you

How to choose the right medical aid option for you

– Tanya Motlafe (Director of  Cornerstone Healthcare Consulting Services)

In a few months medical scheme renewal season is opening and with it comes the once-annual opportunity for medical aid members to upgrade or downgrade to a different benefit option. This sounds much easier than it is, because with so many benefit options across from various medical schemes, the choices are vast and many times, overwhelming. One of the best ways to ensure that you get the best medical cover for you and your family is to appoint a qualified and registered healthcare broker.

For now, Cornerstone Healthcare Consulting Services has put together some questions that will help to guide you when choosing a medical aid benefit option so that you can rest assured knowing that your medical needs will be covered.

What is your budget?

Ensuring that you can afford your medical aid is vital to your financial wellness. If your medical aid contribution is too high, you will most likely end up cancelling your medical aid due to affordability. This will have a negative effect if you ever decide to join a medical aid again in the future, because a late joiner penalty fee may be imposed on your membership depending with your age due to a break in cover for a certain period. With so many different options to choose from, some offering great cover at affordable rates, you’re bound to find the right option that suits you and your pocket.

Do you have any chronic conditions?

Make sure that the plan you choose caters for your chronic needs. Furthermore, the level of cover for chronic conditions will vary greatly between different benefit options. As always, the best way to ensure you avoid nasty surprises and loopholes is to appoint a qualified and experienced healthcare broker.

What are your day-to-day medical needs?

For many, out-of-hospital needs like optometry, dentistry, physiotherapy and psychiatry are just as important, if not more important than in-hospital benefits. If you use out-of-hospital benefits, you’ll most likely need a medical aid benefit option that has a Medical Savings Account (“MSA”). Many benefit options don’t have medical savings account and you won’t have cover for day-to-day benefits, so make sure you choose the right plan for your needs.

Are your comfortable using network providers?

Almost all open medical schemes offer a few benefit options that make use of network providers including healthcare professionals and hospitals. This means that if you choose an option which requires you to make use of a network hospital, you will be limited to certain hospitals for planned procedures (emergencies will still be covered as per your plan type at any private hospital). The bonus of using a network hospital benefit option, is that your monthly contributions are often much more affordable. If you live close to a few hospitals within the scheme’s network, and you are comfortable with using network hospitals, consider this option.

Strongly consider Gap Cover

Gap Cover does exactly what its name suggests – it covers the shortfalls between what the healthcare professionals charge and the medical scheme reimbursement. Many specialists charge private rates in hospital (more than what the medical aid will cover) and that may leave you with a large hospital bill. Gap Cover offers extreme value and is very affordable with most plans starting from as little as R250,00 per month per membership.

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