What to consider when planning your medical aid?

Medical aid is crucial, but deciding between the many schemes and inclusions can be difficult.

We asked Lee Callakoppen, principal officer of Bonitas Medical Fund, what you should bear in mind when making this decision.

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What is medical aid?

Medical aid involves paying a monthly premium in exchange for financial cover for medical treatment. It differs from health insurance in several respects.

Dion Mhlaba, chairman of Wesmart Financial and Administration Solutions, explains.

“A medical scheme pays for services as prescribed within the scheme-specific rules and is controlled through stringent risk management protocols. Health insurance is cover for possible unforeseen events within a stated benefit structure.”

READ MORE: Medical aid plans and hospital plans: What’s the real difference?

What should you consider when choosing a scheme?

Callakoppen lists some items that you need to bear in mind when deciding among the many medical aid products on offer.

1. Healthcare needs

Medical needs differ from person to person, which is why you should do a thorough analysis of what your exact healthcare requirements are. Also remember to factor in the needs of your dependants.

Consider how often you and your dependants visit a doctor, the medication you take, conditions you might have such as high blood pressure or diabetes, and the amount of money you spend on medical services such as dentistry and optometry.

Take into account which of these expenses are once-off and which are likely to be repeated. Once you’ve done this, you’ll be able to decide whether you need a comprehensive medical aid or hospital plan.

2. Small print

It’s important that you take time to read the information that’s been sent to you by your scheme or broker. As Callakoppen says, “Benefits vary from plan to plan, so establish what is and isn’t covered. Ask what supplementary benefits might be available to you that can potentially save significant day-to-day expenses.

“These could include preventative care benefits, ranging from basic screenings (blood pressure, cholesterol, blood sugar and Body Mass Index (BMI) measurements) through to mammograms, pap smears and prostate testing. In some cases, this extends to maternity programs, dental check-ups, flu vaccinations and more. Once you understand what is on offer, you can make an informed comparison and decision.”

3. Making your benefits last

As Callakoppen explains, “Some plans require you to use a specific GP or hospital network from a list of Designated Service Providers (DSPs). This keeps costs down because the scheme will have negotiated special rates with these services providers. Check the network in your area before making a final decision.”

Also consider whether you must be referred to a specialist by your GP, and whether your medical aid offers additional GP consultations once your day-to-day benefits have been depleted.

READ MORE: If someone had your medical aid details, could they benefit in your name?