“We are sorry, but your policy does not cover this procedure. Please pay in cash…”
This is the last sentence you would want to hear in the event of you or your family members being faced with a medical emergency. Imagine if you are in a situation, that even after paying all those instalments timelessly and having specific expectations from your medical aid plan, you aren’t fully covered by your medical aid and are forced to ultimately pay a lump sum amount in cash (cash that you don’t really have).
Sadly, this is the reality for many South Africans that choose the wrong type of medical aid cover and those that simply choose the cheapest option in hopes that their medical procedures will be fully covered. Only 17% of South Africans can afford medical aid or hospital plans and a majority of them don’t understand the plan and procedures that they are covered for. Did you pause to think about the ‘what-if’ scenarios that you may face if you are in a medical emergency? Before you commit to a medical aid, there are important aspects that you need to look at regarding your lifestyle, age, health and your budget.
Know what you want and assess your medical needs – are there special features you may require in your policy? Look at your current financial situation and determine how much you can afford to pay in monthly premiums. Do not compare medical aid companies but rather their plans as this is the biggest mistake – choose a reputable company and get the most for your money. Premiums may vary for full coverage and the same company may offer similar policies at different prices, so it is important to shop around to compare the costs of different medical aid policies. Make sure you read what they have to offer including the benefits, fees and charges as well as any limitations to the specific policy.
The premium is a crucial factor when making comparisons yet it does not tell the entire story – you need to dig deeper. You should ask a lot of questions and read the fine print properly. You can also look at another policy to reveal and compare key points that you could have not noticed.
Once you have done some research, you need to take a moment to think about your own needs and expectations. Ask yourself:
Will you be more comfortable knowing that you have full cover? What trade-off are you willing to make between having to pay, and the size of, an excess or co-payment when you go to hospital verses having a higher premium? How much are you prepared to pay now to help reduce out of pocket costs when you need treatment? Will you have to be worried about large out of pocket costs?
There may be additional procedures that look after a range of important health related services that don’t fall under your medical aid. This may include optical, dietary, physiotherapy, chiropractic, natural therapies, pharmacy and psychology, among others. Most of the additional services are not covered through the public healthcare system or are only covered in selected circumstances. This means if you need to or choose to use one of these services without it being in your medical aid plan, you will generally need to pay the full amount charged for the service.
It is a good idea to speak to family members who already hold medical aid policies, insurance agents and also with financial consultants to help guide you in the right direction, but ultimately the decision is yours.
Essentially, the key points to look at when considering a medical aid policy are; knowing what you really want and what you expect from your medical aid policy, assessing your current financial situation, looking at reputable medical aid policies rather than medical aid companies, do your require additional procedures to be included in your policy and lastly, pay attention to any limitations in your policy as well as the premiums payable.