Durban - Inflation and interest rates are increasing while petrol and food prices are on the rise, these factors have pushed South Africans to look for ways to cut costs by, among other things, exiting their medical aids or reducing their cover.
However, the AfroCentric Group says that your medical aid is the last thing you should be cutting back on.
Dr Mike Marshall, executive manager: research and product development at AfroCentric Group said, “Making hasty decisions about medical aid membership could cost dearly later on, so we urge scheme members to think twice before altering their medical coverage.
But what is medical aid?
According to Rachel Janssens, principal consultant at Alexforbes Health, medical aid schemes are a form of insurance which cover medical expenses incurred at a hospital, medical facility or an accredited healthcare professional.
Dr Marshall shares 6 ways you can manage the cost of medical aid:
Right plan, right cover
Understanding the benefits offered by your medical aid will ensure that you are on the correct plan for your medical needs.
“If you are over-insured, you are paying a premium for benefits you don’t need. If you are under-insured, you will end up having out-of-pocket expenses on co-payments,” Dr Marshall said.
Medical schemes generally don’t offer complete cover long-term treatment plans which needs to be considered when assessing cover.
Late joiner penalties
Members of the age of 35 can have late joiner penalty (LJP) imposed. The cost of penalty depends on the number of years that the person has not been on medical aid.
“A late joiner penalty is a calculated percentage that is added to the member’s monthly contribution and is incurred for life, even if you move from one scheme to another,” Marshall said
LJPs can also be applied if there had been a break in medical aid cover for at least 90 days.
Understanding co-payments
Not all procedures or treatments are fully covered by medical aids. People will have to make payments/co-payments from their own pocket to cover what a medical aid does not cover.
There could be extra costs if a provider used is not included in the medical scheme’s designated network of providers.
Reading up on a medical scheme’s network of providers and hospitals associated before deciding on a plan can help avoid unnecessary costs.
Speak to your local pharmacist
Dr Marshall said, “Pharmacists can provide sound medical advice on issues such as rashes, colds and minor ailments.”
Your savings should be there to cover visits to the doctor as well as prescribed medication that may be more expensive than your average cold and flu effervescent.
Managing chronic conditions
Being diagnosed with a chronic condition can be stressful because the cost of chronic medication can be expensive and people need the treatment over a long period, or in some cases, indefinitely.
If your condition has not been registered, the cost of the medication will come out of your acute or savings benefit and then your pocket when your savings have been depleted.
Instead, register your chronic condition so payment for your medication can be made from risk and not your savings. Speak to your doctor about prescribing medication on your plan’s formulary which you can get from a network pharmacy or a designated service provider.
Contact a broker
You should check with your financial advisor or broker if your medical scheme has an Efficiency Discounted Option (EDO).
EDOs offer the same level of benefits, but at a discounted price if you are willing to limit yourself to using network providers, according to Marshall
“This is why it is important to speak to a broker who can help you determine exactly what you need and how you can get the most value for money in a tough economic climate.”
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