My medical savings are depleted, what do I do now?

– Tanya Motlafe (Head of Cornerstone Healthcare Consulting Services)

The Winter flu season has a way of wreaking havoc on medical aid savings account (“MSA”) and many South Africans are stuck wondering how they will cover their day-to-day medical costs until the end of the year. If you are wondering the same thing, this article is for you. Here are a few tips on how to survive the post-MSA struggle until December.

Your chosen benefit may have unlimited GP visits or addition GP visits

It’s very important that you know what your chosen benefit option covers and to what extent. You may find that your depleted MSA is less of an obstruction than you may think. For example, medical scheme Health benefit options include an additional GP visits that provides full cover for GP consultation fees, even if you have spent your full MSA allocation. Similarly, scheme B offers unlimited GP visits on their capitation option, whilst scheme C may offer the GP visits as an addition to you allocate MSA. The benefit might be offered alongside your MSA. Make sure you know and understand these benefits, otherwise you may be paying for services from your pocket that may be covered under your membership.

Consider making use of the designated healthcare providers.

Most medical schemes have contracts with healthcare providers through out South African provinces. If you use a doctor that is contracted with the scheme, it will mean that you will be charged medical aid rates and your claim will be paid in full. This will stretch your MSA and with no shortfalls on your doctor’s consultation. Having your medical aid to cover everything, is something we all want and just never get it. However, using healthcare professionals that are contracted with the scheme, will give you full cover.

Prescribed minimum benefits will still be covered in full

Prescribed minimum benefit (“PMB”), is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected, as set out by the Council of Medical Schemes. PMB’s will include medical emergencies on listed procedures, Chronic conditions, and other diagnosis treatment like mental health. The treatment will still be covered in full, regardless of whether your MSA has been depleted or not. This means that even though you have no more medical aid savings left, you can rest assured that you and your family are safe from a variety of illnesses. The PMB list covers nearly 300 illnesses including chronic conditions such as asthma, diabetes and epilepsy. It also covers various cancers, some cardiac treatments and many emergency treatments. Click here for a full list of PMB’s as defined by the Council for Medical Schemes

Get expert advice from a healthcare broker before upgrading or downgrading your plan

When you have depleted your MSA, your first reaction might be to upgrade your plan at the end of the year or even downgrade sooner because you feel the MSA wasn’t as helpful as you imagined. Remember, there are many reasons why your MSA could have depleted so fast – for example not making use of network providers or opting for generic medicine. Try to avoid making any rash decisions. Instead, get in touch with an expert healthcare consultant who will be able to give you advice and help you to choose the best plan for your needs.

If you are unsure about your current MSA or if you feel you need assistance with choosing another medical aid benefit option, contact Cornerstone Healthcare Consulting Services today for expert medical aid advice. Also, remember to follow us on Facebook and LinkedIn for more interesting and useful content and share this article with your friends and family.

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