If it was left to me, I would choose the medical aid scheme with the best rewards programmes that offered the highest discounts on flights, gym and gadgets. Fortunately, I’ve gotten advice from someone smarter than me, and who is less swayed by bright shiny stuff, and more by decent medical cover at a decent price.
Choosing the right medical aid scheme in South Africa, one that covers your family’s medical needs at an affordable cost, can be difficult, especially as cover becomes more expensive. And when I watch moms lamenting on Twitter about how they’ve run out of cover or savings for day-to-day medical expenses, despite paying high monthly rates, it only drives home this fact.
Often there are many different options and companies that each have slightly different offerings, but how do you know which will meet your needs? Inevitably the temptation is to go for the option that gives you lifestyle benefits like cheap movie tickets or discounts on hotels. While it’s important to take into account the extra savings these benefits may offer, I’m told the primary focus should always be on the medical cover provided (and not the cheaper gym contract, I keep telling myself).
Some points to consider, via my savvy financial advisor:
• Hospital cover – any good medical aid should cover you when you’re admitted to hospital but there may be some restrictions depending on the option you choose. For instance, will they only cover non-emergency treatment in hospital that are in their network, or can you choose the hospital you prefer? Are there network hospital close to where you stay? Remember that many specialists only practise at specific hospitals, which may not be included in the medical aids’ network.
• Chronic medication – if you or anyone in your family suffers from a condition that requires chronic medication then it is imperative to check whether the ailment Is covered by the medical scheme option you’re considering and in addition to this whether the specific medication required is covered or if you would need to make a co-payment towards this.
• Savings/day-to-day benefits – you will have the option of either choosing a hospital plan option which will cover you when you’re admitted to hospital, or a more comprehensive plan that will offer you day to day benefits for e.g. GP visits, medication etc. What is best for you and your family would depend on how frequently you visit the doctor, and past expenditure will give you an idea of how much you’d need in savings for a typical year. Savings that are not spent in one year will carry over to the next year so you don’t “lose” any money you don’t spend. Some schemes also pay for certain day-to-day services like GP visits directly, which means you don’t have to dip into your savings.
• Doctors’ charges – many doctors, especially specialists, no longer charge medical aid rates so a scheme that will pay doctors at 200% or 300% of medical aid rates may save you from a nasty bill if you need an operation or procedure.
There are many factors to consider when choosing the best affordable medical aid that covers you and your family’s medical needs. What’s important is to consider your family’s circumstances, and choose the option that balances these factors best for you and them.
