Bonitas Member Magazine B-Living Issue 4 | Page 21

Medical aid made easy
With all the medical aid options on offer, which include everything from comprehensive cover to a
simple hospital plan, one wouldn’t blame you if you are confused or struggling to make a choice.
Here are some pointers to help make the decision easier. However, caution that due diligence and
some homework are required ahead of making a final decision.
What are your needs?
The most important factor is to know what you and your
family need in terms of cover and what suits you best.
• Reflecting on your family’s health history to gauge the
number of visits you make to the doctor and the cost of
medication
• Whether anyone has a chronic condition or needs to
see a specialist
• How much you spent – or need to spend – on dental or
eye care
• If you already have a medical plan, check what was
covered, how much your co-payments (if any) were and
whether your savings for the year were adequate.
What is your budget?
Once you have an idea of what you might need for the
year ahead in terms of healthcare, then it’s time to look at
your budget. What can you comfortably afford to spend
to get the medical cover you need? (The rule of thumb
is contributions should not exceed 10% of your monthly
income.) Once you have these two scenarios, then it’s
time to compare the various plans and see which best
matches your needs and budget.
What benefits will you be getting?
Benefits vary from plan to plan, so check what is covered
by the one you are considering and look at whether it
offers supplementary benefits that can potentially save
significant day-to-day expenses. These could include
anything from wellness screenings (blood pressure,
cholesterol, blood sugar and BMI measurements) through
to maternity benefits, flu vaccinations, mammograms,
pap smears and HIV tests. All of these are costly if you
have to pay for them yourself.
gives you at the beginning of the year. You can use your
savings for daily out-of-hospital medical expenses, such
as GP and specialist consultations and over-the-counter
medicine. It is imperative that members use their savings
and day-to-day benefits wisely to get maximum value for
money.
What is gap cover?
Gap cover is an insurance policy you can take out to help
pay for the shortfall between what your medical scheme
pays and what the hospital or specialist might charge.
The amount paid out depends on your policy but most
people usually combine gap cover with a hospital plan.
It is important to note that gap cover is not offered by
medical schemes and is a separate health insurance
product.
From 1 April 2017, the same requirements for a medical
scheme have been introduced, including a waiting period
of between 3 and 12 months for certain conditions and
a payout limit of R150 000 a year for each person. Please
sms ‘MedGap’ to 43366 to speak to a consultant about
gap cover.
And a hospital plan?
Provides you with basic, yet important medical cover and
essentially covers all your required in-hospital procedures
and check-ups, including the 27 chronic conditions (or
PMBs). However, a hospital plan does not provide cover
for day-to-day doctors’ visits, prescribed medications,
chronic medication and related expenses. Some hospital
plans offer value-added benefits, so read the fine print,
and ask questions to make sure you are getting what you
need.
In terms of the Medical Schemes Act, there are 26
common chronic illnesses, known as Prescribed Minimum
Benefits (PMBs), which all options on all schemes are
required to cover for medication and treatment.
What are savings?
One of the most misunderstood elements of medical
plans is how the day-to-day benefits work. Medical
savings are a fixed amount that the medical scheme
B-Living Issue 4, 2017
Page 20