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How to choose the right medical aid

Oct 17 2014 12:48 Susan Erasmus and Matthew le Cordeur

Are you a kite surfer with no medical aid? There might be a medical aid that will suit your needs. (Photo: Shutterstock).

Cape Town – A hospital plan is not a one-size-fits-all as you need to consider the cover you need, how much money you can spend on contributions, and whether a specific plan has any features that don’t suit you.

There are many options to choose from and before you make a decision, you need to ask yourself a few questions:

– How much do I want to spend?
– How much does it cost to register a spouse or a dependant?
– Can I handle my own day-to-day expenses?
– What is the current state of my health?
– Does the plan specify the use of network hospitals? Is there one close by?
– Is there a co-payment for hospital procedures?
– What is the agreed fund tariff that the plan will pay? 100%? 200%?
– Will the hospital plan pay for hospice care and psychiatric hospitalisation?

An important thing to remember is that if a hospital plan pays 100% of the agreed scheme tariff for hospitalisation, you will have to pay the difference if the hospital bill is higher. Always use network hospitals or designated service providers if at all possible. It could make a difference of thousands of rand to your final bill.

Even if schemes specify that there is no overall annual limit, they very carefully monitor high-cost cases.

Prescribed minimum benefits are “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” according to the Council for Medical Schemes. All hospital plans have to pay for treatment for these conditions.

The list below is by no means comprehensive and these details will change in 2015. Go to the websites of the specific schemes mentioned here for the full details of the hospital plans available and the benefits they offer.

Fedhealth’s tips on choosing the right medical aid

Once you’ve chosen a medical aid, choose the option that best meets your medical needs, Fedhealth said. “Who are you, are you single, active and just starting work,” the medical aid group asks. “You need cover for accidents and sport injuries and catastrophes that can hit anyone, anytime.”

“You want to know that you’re in good hands and will get the best treatment,” it said. “Some hospital plans restrict you to specific hospitals. In this case, make sure you’re close to one of those network hospitals.”