by Susan Erasmus

A healthy medical cover

Know what to look for when choosing a medical cover or hospital plan

A healthy medical aid plan means you won't have to worry about running out of funds
A medical cover or hospital plan

Medical cover can bite a huge chunk out of your income every month. How do you make sure that the cover you choose is the right one for you?

Here are 10 things you need to consider.

Full cover or a hospital plan. Decide whether you can afford the normal day-to-day medical expenses, such as GP visits yourself. Hospital plans are more affordable than full medical cover. Remember that hospital plans cover you for 26 specified chronic conditions (known as PMBs).

Check your health. If you suffer from chronic medical conditions, such as diabetes or arthritis, you might need full medical cover rather than only a hospital plan. If you are generally healthy, but have eyesight or dental problems, choose a scheme that makes adequate provision for this.

Assess your finances. Full medical cover can be expensive. If you have a monthly income of R3000, you cannot spend R1000 of it on medical cover. If you decide to join a scheme,  check who gives you the best deal for your spouse and children, and what your monthly contributions would be. 

Check a scheme's payment record. If you have to choose an open scheme, phone your GP's secretary, or the nearest private hospital, to find out whether they have experienced problems with pay-outs from that particular scheme.

Check a scheme's solvency ratio. Any broker should be able to give you the latest information on this. The last thing you want is to pay your premiums and then find out that the scheme has gone under while you were in hospital. According to the law, schemes should have at least 25% of members' annual contributions in reserve.

Scrutinise the benefits. A scheme may look wonderful on paper, as they appear to pay 100% of the cost on a variety of things, but do check what the day-to-day limits are and how much your Medical Savings Account (MSA) is per year. If the MSA is small, you could exhaust your day-to-day cover by February. Also, many private hospitals do not charge medical scheme rates - you could be landed with a nasty bill after your hospital stay, despite having hospital cover. Check what co-payments you will have to make on all bills. It might be an idea to go for an option that pays 200% of the medical fund rate for hospital treatment. 

See an independent broker. This person is not paid to promote a single scheme, and will be able to help you choose the scheme that will be the most beneficial to you.

Find out about exclusions. Some schemes may exclude you from claiming for certain conditions for a limited period of time (usually not more than one year). Be aware of these possible exclusions before signing on the dotted line. 

Check overall hospital limits. If a scheme limits its hospital payouts to R500 000 per family per year, what would happen if you were all in the same accident? Find out what a week or two in hospital would cost for you and your family - you may be shocked.


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Issue 16


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