Time to Review your Medical Cover

Time to Review your Medical Cover

Towards the end of every year, many medical schemes announce their annual contribution increases for the following year. This makes these last few months of 2018 the perfect time to review your cover and make any necessary amendments, as, until the start of December, most medical aid providers will allow you to change plans or options without penalties.

Alternatively, if you are not happy with your provider, you can even go as far as to switch medical schemes, just be prepared that a new scheme may come with a waiting period of up to six months (during which time you will only be covered for emergencies), and may also charge you higher premiums or penalties, depending on your age and circumstances.

Your medical cover requirements can easily change from year to year — financially and medically speaking — so it makes sense to take this opportunity to review your plan and understand how you are currently covered and whether that is still appropriate. Granted, it’s hard to predict how much you may incur in terms of future medical expenses, so it is difficult to know which plan to choose. However, that is why it’s important to review your medical cover annually to ensure that your plan is in line with your health concerns and budget.

If you aren’t sure about whether you should change your options, start by first calculating how much of your medical expenses over the past year was covered by your medical aid. Once you have worked out this amount, you can then decide whether it would work out more cost-
effective to pay a higher monthly contribution in return for more benefits, or switch to a cheaper option and simply pay more out of your own pocket if the need arises.

If you are relatively young and healthy, you hopefully won’t require much medical attention next year, so it may be worth considering a low-cost option. However, if you are older, suffer from a condition or have a precarious family medical history, it may pay to upgrade.

Money issues

As contribution increases for medical cover tend to be above the Consumer Price Index inflation rate each year, affording adequate cover can be a concern for many people. The good news is that medical schemes and day hospitals are trying to collaborate in order to tackle the high cost of healthcare in South Africa. Procedures at a day hospital are less expensive and you can avoid any unnecessary overnight stays that can end up adding a lot to the bill.

It’s also a good idea to make the most of any opportunities that your medical scheme offers to improve your general wellbeing. Most schemes nowadays offer wellness programmes and reward you for living healthily. If you can be proactive and stick to a programme, the benefits can compensate for some of the costs of your cover.

If funds are currently tight for you, be sure to at least have a hospital plan, which will cover you for certain chronic conditions and hospital admissions. By law, even the most basic of medical schemes should also provide Prescribed Minimum Benefits (PMBs) that will ensure you are covered if you have a life-threatening or chronic condition that is on the PMB list. However, you may need to meet certain requirements before some schemes will cover you.

You could also choose a network option, which is cheaper but means you will be limited to certain healthcare providers within a network. This means that if your nearby hospital or GP isn’t a member of the scheme’s provider network, you may need to change doctors or be prepared to travel further to have an operation or see a specialist. However, the cost of some network options is calculated based on your monthly earnings, so they will come with lower premiums if you’re not currently earning a comfortable salary.

You could also choose an option with a medical savings account, whereby up to a quarter of your monthly contribution goes into the account and the full savings amount for the year will be available from January. Once you have depleted the funds in your savings account, you will need to fund any further medical expenses. So if you don’t feel that a savings allocation will be sufficient to meet your needs, you may be interested in getting threshold cover, whereby any unused savings each year will roll over.

If you do wish to consider changing plans or options, be sure to thoroughly review all benefits and conditions. Take the time to understand how your cover will change, and it’s advisable to contact your provider to clarify all details. For example, if you change to a lower-cost option, it’s possible that you may no longer be covered for certain medication or treatment, such as antidepressants or anxiety medications; or you may be covered for a different brand of medication to that which you previously used.

Don’t hesitate to also arrange a meeting to discuss your financial situation so that you can decide what steps you can afford to take with regards to your medical cover.

(Info from iol.co.za)

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