How to choose a medical aid plan

It’s that time of year again. Many major medical schemes have opened up brief, annual window periods in which members can change their plans. Clueless? Contact your medical aid to find out about specific deadlines.

While cost is the first thing most people look at when reconsidering their medical aid cover, it’s not the only factor to consider.

Bhekisisa spoke to three of the country’s biggest schemes to find out the four questions you should ask yourself before you ditch your current plan.

1. How much did you spend on healthcare this year?

Before deciding to change your medical cover, it is important to add up your typical healthcare costs, says Bobby Ramasia, principal executive officer at Bonitas Medical Fund. These should include day-to-day expenses such as doctor’s visits or chronic medication, as well as less frequent costs such as hospitalisation or specialist care.

“Then consider which of the expenses listed above were one-off and won’t come up again soon [such as childbirth] and which are likely to come up again and again [such as flu],” says Ramasia.

2. What are your needs?

The level of healthcare cover you need is determined by factors such as your age and your health status.

“Young, healthy people and people with no or few financial dependents typically could need less cover. If you’re older, in poor health or have a large family, you may need more comprehensive cover than that offered on a hospital option only,” says Deon Kotze, head of research and development at Discovery Health.

3. What are your options?

Once you have determined your needs, compare the benefit options that are available. Read the fine print. Make sure you know what’s covered and what’s not.

“We always encourage our members to ensure that they understand how the different benefit options operate and select the most suitable option according to their healthcare needs and affordability. It is also essential to read the scheme rules before changing the benefit option to ensure that the member’s rights and responsibilities are understood,” says Liziwe Nkonyana, head of communications and member affairs at the Government Employees Medical Scheme.

4. How much can you afford?

Before making a final decision, consider all of the costs involved. These go far beyond just how much you’ll pay in premiums each month and can include co-payments for medication or procedures not covered by the scheme.

Ramasia says: “As a rule of thumb, your medical aid contributions should not exceed 10% of your monthly income at an individual or household level.

“Co-payments usually apply to specialist or elective medical procedures. These will differ from one scheme to another. It is one of the reasons why you should always do thorough research before deciding which medical aid scheme is the best option for you. The ideal option would, of course, be the one that does not require many or any co-payments from the member.”

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Ina Skosana
Ina Skosana was a health reporter at Bhekisisa, the Mail & Guardian’s centre for health journalism, from 2013 to 2017.

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