How to choose a medical aid

Now is the time to be re-looking at your existing medical aid cover or, if you are wanting to join a scheme, investigating which one suits you best.

MyBroadband, 21 October 2016

Most medical schemes have launched their benefits and contributions for 2017 and it is the time when you should be re-looking at your existing medical aid cover or, if you are wanting to join a scheme, investigating which one suits you best.

The medical aid landscape can be tricky to navigate so it is important to compare options and schemes to ensure you find a medical aid that works for you and your family's health and is within your budget. Dr Bobby Ramasia, Principal Executive Officer of Bonitas Medical Fund, helps guide you through choosing the best plan, whether it's through the open market or through an employer.

If you are already on a medical aid scheme
Before you choose the best medical aid option, you need an idea of what your typical health care costs are.
You should also consider the following for you and your dependants over the past twelve months:

• How much you spent on day-to-day healthcare expenses
• Where you or any of your dependants admitted to hospital
• Did you need to visit a specialist regularly
• How much often do you or your dependants visit a GP
• Do you and your dependants have any chronic conditions
• How much do you spend on dentistry, optometry and over-the-counter medicine
• Did you exhaust your day-to-day benefits and/or savings this year
• How much did you pay in co-payments and/or deductibles

The day-to-day detail:
Often the cost containment measures medical schemes apply for the day-to-day benefits are broad.
So investigate, or bear in mind, the following:

• Does your medical aid contract with doctors and specialists and, if so, are you willing to use them? Using contracted or network doctors usually means obtaining full or improved cover levels, while using doctors outside of the network usually results in restricted benefits or co-payments. It also helps ensure you are getting more value for money as doctors on your medical scheme's network will not charge you more than the rate agreed with your medical scheme.
• Must you be referred to a specialist by your GP?
• Does your medical aid offer additional GP consultations, which they will pay for, after you have exhausted your day-to-day benefits?
• Does your medical scheme offer any additional benefits such as maternity, preventative care or wellness benefits that are paid from risk and not savings or day-to-day benefits?

You can also follow these tips to get more value for money:

• Use generic medication wherever possible - get into the habit of asking your doctor and pharmacist about this
• Try to keep your claims within any specified sub-limits, e.g. optometry
• Find out if your option has any day-to-day benefits that are paid by the scheme from risk (not from your day-to-day sub-limits or savings). Two examples where this sometimes applies are dentistry and optometry.

Additional benefits:
Ask what supplementary benefits might be available to you that can potentially save significant day-to-day expenses.
These could include the following:

• Preventative care benefits, ranging from basic screenings (blood pressure, cholesterol, blood sugar and body mass index measurements) through to mammograms, pap smears, prostrate testing. In some cases this extends to maternity programs, dental check-ups, flu vaccinations and more. These usually require authorisation from the scheme, failing which they are simply met from your day-to-day benefit limits. A mammogram costs in the region of R900, so don't look a gift horse in the mouth!