Simplify Medical Aid!

Is choosing a medical aid scheme difficult?

Many medical aids are in trouble. They can only increase premiums or reduce benefits to keep going.
You need to carefully look at the benefits you are getting from a medical aid.
Medical aids offer various plans, the lower the cost - the lower your benefits!

Here's a simple guide on what you should look for in a medical aid;

PRICE
Private hospital benefit medical aids are expensive. Network medical aids are salary-related affording the lower learner the chance to join a medical aid, BUT you must use their providers.

IN HOSPITAL COVER

• PRIVATE vs MEDICAL AID RATE
  Private providers charge up to 5 times more than what the medical aid rate pays, so if you want to use private providers you need a private rate scheme! Very few schemes pay private rates in hospital. GO HERE TO SEE ONE.

• NETWORK MEDICAL AID
  You only use the scheme's providers. You get good benefits for a reasonable price. GO HERE TO SEE ONE.
  There are a few co-payments.

• OVERALL ANNUAL LIMIT
  You cannot know how much your hospital stay will cost, so you should consider a no overall annual limit scheme.

• BENEFIT LIMITS
  Certain treatments are limited. Make sure you know what you can spend for treatments like cancer, kidney dialysis and prostheses.

• CO-PAYMENTS
  Do you have to pay extra for some procedures like in-hospital dentistry? Are MRI and CT scans fully paid for?
  Are diagnostic scans like gastroscopies and colonscopies paid in full? GO HERE TO SEE ONE THAT PAYS ALL THESE.

• IS 24 HR TRAUMA CASUALTY PAID?
  Many schemes do not cover trauma casualty. GO HERE TO SEE ONE THAT DOES.

• IS THERE POST HOSPITAL COVER?
  Does the medical aid pay for any treatments after you are discharged? GO HERE TO SEE ONE THAT DOES.

OUT OF HOSPITAL COVER

• SAVINGS
  Medical aids give you an amount of money to spend on all your day-to-day costs. The higher your premium - the greater that amount of money to spend. (It's you money anyway!)
  Some schemes will pay your GP visits and basic dentistry, without reducing your savings! GO HERE TO SEE ONE.
  Others offer subsidised GP and specialist costs - but you have to us certain providers. GO HERE TO SEE ONE.
  Some treatments like medicines and glasses are limited, even though you may have savings left or be in the safety net - where the medical aid is paying.
  Some pay prescribed medicines at a low rate - make sure you know what is paid!

  What happens when you savings are used?
  Some medical aids have a safety net where once your out of hospital claims have added up to a certain amount, they help with further claims that year.
  Some safety net benefits are limited. Others make you pay everything.

• NETWORK MEDICAL AID
  You use certain providers only. For that, you get unlimited basic day-to-day care and some specialist care paid for.
  There are co-payments to be aware of.

• PREGNANCY
  No medical aid will pay for pregnancy- related claims if you are pregnant when joining the scheme.
  Most will cover your baby from birth though - if you are a member at the birth.

• EXCLUSIONS
  All medical aids exclude certain treatments. Make sure you know what is excluded.

• CHRONIC MEDICINES
  All schemes cover the 27 Prescribed Minimum Benefit conditions. Others cover over 60 chronic conditions.
  All medical aids have lists of medicines they pay. Make sure your medicine is covered.

DEPENDENTS
Most medical aids charge adult rates for dependents older than 21 - even if they are still dependent upon you. One charges child rates till age 27.This is a significant saving! GO HERE TO SEE.
Some allow child dependants up to age 30. GO HERE TO SEE.

UPGRADING YOUR COVER
All medical aids allow you to change your plan in January every year. One allows you to change during the year!
Some do not even allow a downgrade! GO HERE TO SEE.

WAITING PERIODS
All medical aids can add waiting periods. They consider your application and decide on your age and the answers to the medical questions. A waiting period is the period during which you will not be covered for medical expenses incurred, even though you may be making contributions to the scheme.

There are 2 different waiting periods;
3-Month General Waiting Period during which a member is not entitled to claim any benefits - except hospital medical expenses as a result of an accident.
12-Month Condition Specific Waiting Period during which a member is not entitled to claim any benefits for a condition for which medical advice, diagnosis, care or treatment was recommended or received in the 12-months before the date on which membership was made. This includes pregnancy.

A waiting period will usually apply if;

• You have not been a member of a registered medical scheme for at least 2 years before joining the medical scheme or
• the break in membership between leaving your previous scheme and joining the new scheme is more than 3-months
• the change in medical schemes was not as a result of changing employment.

Waiting periods are determined by the medical scheme itself, after processing your application. The scheme makes the decision. I cannot confirm a period until your application is underwritten.

So, the sooner you send me the application, the sooner we can see the schemes decision!

LATE JOINER PENALTY
Any new member of a medical aid - older than 35 - is subject to one. You need to prove past years of membership NOT to have one imposed. Any lesser period will result in a penalty. Only once I know how many years you were on a medical aid, can I confirm any penalty.
You can provide either a Certificate of Membership from all past medical aids, or if you cannot, an affidavit attesting to membership form a Commissioner of Oaths with your application.

WHICH PLAN?
Whilst it is not for me to choose your plan, herewith some pointers...

• Your greatest risk lies with private hospital costs. So, if you want Private Hospital cover, you need a plan that pays at 300% of medical aid rates!

• The main difference between the plans then lies in how much you have for out of hospital claims
  Remember, this is but a return of your money anyway - as the more you want, the higher your contribution!
  Yes, you do get it in a credit lump sum up front at the beginning of the year, but they do charge a fee for that.
  So if you can pay out of hospital costs yourself, you may gain by taking a hospital only plan or a plan with a lower out of hospital benefit - consequently a lower premium.

It really depends upon your budget and the best plan to meet your out of hospital needs.

To investigate some medical aids please GO HERE.

If you want to investigate one of the above medical aids, simply mail me the MEDICAL AID REQUEST FORM ON EACH MEDICAL AID PAGE and I will send you some options to consider. NO OBLIGATION!

Use my services.

An independent medical aid adviser. I promote many companies and can find a plan to suit your needs.

I am accredited with the Council of Medical Schemes and am in a position to give you comprehensive advice.

If you have a MEDICAL AID concern, please contact me today. Make sure your are FULLY covered! Cell: 083 377 8893

The last thing you need is a financial shortfall when you are trying to recover!

Don't leave your concern here. Call me for advice - no obligation!

Especially if you are considering Medical Aid.

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Council of Medical Schemes