This is why you should ask your medical scheme for an annual claims statement

Even with a strict budget, a lot can happen in a year and you may lose track of your medical expenses, especially the costs that you cover out-of-pocket.

It’s important to regularly assess your medical aid or health insurance contribution, and to establish whether you’re getting your money’s worth. We find out how your annual claims statement can help.

What is an annual claims statement?

According to Deon Kotzé, head of research and development at Discovery Health, an annual claims statement provides members with a claims transaction history.

“This provides members with a detailed view of claims submitted to their medical scheme, by or on behalf of the member,” says Kotzé.

“For each claim, the details of payments made by their medical scheme on those claims are shown, and where claims were not paid in full, the reasons for partial or no payment is provided,” he explains.

How can your claims history help you budget?

If you make sure to submit a claim for every one of your medical expenses, then your annual claims history can act as an annual statement of all your medical expenses.

For example, if you need to go for physiotherapy but you know that your medical aid does not cover this cost, you should still request that your physician attempts to claim it.

If they do this, your claims history will state that you had physiotherapy and it will include the cost and date of the claim, but it will state that your medical aid did not cover this cost.

By doing this with all of your medical expenses, you will slowly create an annual record of your expenditure. You will then be able to use this when you assess your annual medical costs.

READ MORE: Four steps to rethinking your budget

If you realise that you’re spending a lot of money out-of-pocket, it may be more cost-effective to upgrade your medical aid or health insurance. On the other hand, if you realise you have very few medical expenses, it may be best to downscale your medical plan.

Kotzé adds that your medical scheme can also provide you with a tax certificate.  

“The tax certificate reflects all valid medical expenses incurred by the member that were not reimbursed by the medical scheme, which can be submitted to SARS for tax filing purposes,” says Kotzé.

How to choose a new medical plan

Kotzé believes that the most important consideration when choosing a new or alternative medical aid plan is the healthcare needs of the member and their family, which must be balanced against affordability. 

“Financial advisers can assist members in this regard, since they can guide members through an analysis of their medical and financial needs in order to arrive at the medical aid plan that is most suited to their health and financial needs,” says Kotzé.

READ MORE: Sceptical about financial advisers? Here’s how to find one you can trust

He explains that these needs may vary from simply protecting the member against the cost of major medical expenses, such as emergency hospitalisation or treatment for cancer, to providing comprehensive cover for the management of specific healthcare needs, such as diabetes or maternity.

“For many members, managing the affordability of their medical aid plan is a major consideration. It’s important for these members to understand the options available to them,” says Kotzé.

According to Kotzé, alternative medical aid plans do not necessarily need to be a downgrade of benefits. The same cover may be available on another medical scheme at a lower cost. Alternatively, the contribution for the same benefits could be reduced by electing a network-based version of the member’s current plan.

If you’d like to consider another medical scheme, get a quote for medical aid here.