There are so many schemes and plans option available, so much technical wording and a lot of confusing information available, that you must use an Independent Medical Scheme Broker!
And I can help you FOR FREE!
You face 3 financial risks with medical costs:
In an attempt to keep an affordable medical cover plan, many members are joining lower benefit and cheaper plans.
(Remember, the greater the benefits of a plan, the higher the costs. Read this...)
So, they are considering options that have a smaller day-to-day medical savings funds or no savings plan at all.
But, whatever you do, never be without hospital cover!
If you are on a tight budget, you may have no option, but to reduce your contribution.
However, please try to consider other areas of cost saving before you consider changing your medical scheme.
And if you still need to change your medical cover, your options are as follows:
1. Hospital ONLY benefit plan with your OWN day-to-day savings.
If you can save for normal day-to-day medical expenses, such as GP visits, yourself consider an in-hospital only plan. It is far more affordable than a comprehensive healthcare plan!
You must cover private hospitalisation and dental costs as this is where unexpected high expenses happen. The greatest healthcare finance risk we face is private hospital costs.
Next, is the cost of dentistry.
Most members can afford GP and chemist bills, but 6-weeks in intensive care or wisdom teeth removal can be extremely expensive!
So, "insure" these two areas of risk, self-fund the balance of costs and you will have an affordable plan, that gives you security that unexpected high costs will not bankrupt you!
Consider joining a private hospital plan, because it will pay:
Some schemes also offer cover for:
Many happy medical scheme members are doing just this, as they feel secure in knowing they are protected from these high medical costs.
All schemes offer plans that cover in-hospital costs only, but some have very attractive advantages!
By joining this plan, you address your 2 greatest medical expense risks - private hospital and dental costs - AND can use any provider you want - all in one plan!
Not only that, but it has had the lowest rate increase of any hospital plan over the last 8-years!
That's good news! Check it as you will not be disappointed!
Yes, you do pay your own out of hospital costs, BUT I can virtually guarantee you that your saved contribution amount, will - over a year - add up to more than the savings in a comprehensive plan!
Take that “saved” amount – over a comprehensive plan rate and save it yourself.
It is your money to spend as you wish - no restrictions, as you control your savings and have access to the funds when you need them!
You can’t use money savings fund as you wish!
You can’t spend it on a holiday, or for your retirement.
In fact, you can only get any balance back 6-months after you leave the scheme!
However, it is your money!
You “saved” it as part of your monthly contribution. Is that fair?
Surely you could do better investing your own savings. Of course you can!
This way of funding out of hospital costs, is really the same as a comprehensive plan savings. The only difference is that a medical scheme will give you credit for the year - up front in your savings -whilst your own savings take time to grow. BUT, at least this money is yours.
Create a savings plan in a bank account, or use your home bond as an access account!
I personally, added extra to my home access bond! In this way, I lowered the capital loan of my bond, saving a huge amount of interest, which far outweighs any return I get with a medical scheme savings account!
And I have access to a large savings fund, should I need it!
Cover for additional members and children is very affordable, making this an excellent option for young families, low-income individuals, retirees, or people in good health who only need private hospital and dental cover and can comfortably pay their day-to-day expenses.
You will have unlimited private hospital cover, paying up to 500% of the medical acheme rates, with essential dentistry benefits and no network providers!
Unbeatable benefits and cost!
If you are not happy to self-fund day-to-day costs, consider plans that offer hospital, chronic illness and day-to-day benefits through the use of a savings fund account.
A savings fund can be a great help when you have high out of hospital medical expenses and do not have the cash flow to meet them. It will allow you to get immediate medical treatment and medicines, speeding up your recovery.
The savings account is a fund of your own money, created from an amount added to your contribution. The Medical Schemes Act, allows you to save up to 25% of your risk premium in a savings account.
(Note that if you accumulate a credit savings balance, you cannot withdraw the cash.
You can only access it when you terminate membership and as long as you don't join another plan with savings option - as the funds are transferred.)
If you can minimise the amount of the savings fund you feel you need - you could drop your contribution by that savings portion!
A few schemes do offer few plans with different savings contributions to meet these member preferences and one scheme even allows you to design and use savings as and when you want to!
You only start repaying the savings once you use them.
There are plans that have a safety net benefit, should you have high out of hospital costs and use up your savings.
These plans are very expensive and you need to carefully investigate your situation to see if you really need that threshold benefit.
Most members only reach their threshold benefits late in the year, so they do not use the benefit fully - yet have paid for it!
It may well be that the cost of a threshold benefit is higher than the actual expenses you pay and it would be cheaper to pay those costs (after your savings are used) yourself?
You may not need high savings for out of hospital benefits, but still want the safety of having some day-to-day cover should the need arise?
Or you may be young and/or healthy and only need a fund for unexpected expenses?
This type of plan will cover your hospital and chronic needs.
You have access to a savings account for day-to-day expenses that works in a different way to the standard savings model.
Suitable for people who are in good overall health, but do incur occasional medical expenses out of hospital.
Schemes also bundle maternity benefits into these plans, making them an affordable option for young mothers-to-be.
Here are 2 of these types of medical schemes:
1. flexiFED plans give you more control, flexibility and choice over your medical plan. And they costs less!
They offer in private hospital cover, chronic condition benefits and a unique method of using savings for day-to-day costs.
Now, for the first time ever, FlexiFED allows you to begin paying for day-to-day benefits only when you use them - not before!
You pay back the amount you have used over 12 months, interest-free!
Here’s how you save… normally members are charged for day-to-day benefits from the beginning of the year regardless of whether you have used your savings or not!
But, with these plans, your contribution will be lower, until you use your savings, as only then do you begin to pay those used monies back - interest-free.
Yes, the longer you delay using the savings account - the longer you experience lower premiums!
2. How about a plan that offers unlimited network private hospital cover, guaranteed full cover for network in-hospital specialists, chronic medicine, unlimited network GP consultations, a list of defined acute medicines, a dental check and an eye test – all with a small co-payment when you need to use them?
And it offers specific sports-related injury benefits!
You only pay for certain out of hospital costs when you need them, not as part of a monthly contribution, therefore avoiding having to pay for savings that you don't really need!
At the beginning of a year, all medical providers and medical schemes decide on the cost of a procedure. That is known as the scheme (medical aid) rate. Schemes then pay at that rate.
If you use private providers, they can charge what they want - known as the private rate. This can be 5 times more expensive than the medical scheme rate!
Medical schemes now offer more expensive plans that pay up to 3 times their scheme rate but, these more expensive and can still leave you with a claim shortfall.
Schemes are also increasingly adding co-payments for certain in-hospital procedures. Again, more expensive plans have fewer co-payments.
What can you do to address this threat?
If you use network providers, they charge what the plan pays, so you should never experience an in-hospital claim shortfall.
Or, better, buy a Top Up/Gap plan that will pay any in-hospital shortfall and co-payment.
You can now consider a lower cost plan paying scheme rates (not the more expensive 2 or 3 times scheme rate), because you are protected against shortfalls from high in-hospital costs!
Every member should have an insurance-based Top up plan.
It is a vital part of having a full in-hospital benefit, healthcare plan!
Schemes who contract with providers can control costs. If you use these providers (chemists, GP, specialist or hospital networks), you can get discounted contributions -as much as 35% lower -even on high-end options with comprehensive benefits!
And the scheme may continue paying GP costs, even if your savings have been depleted!
Medical schemes offer these preferred provider network plans at a lower cost and you should investigate them.
If the providers are acceptable, then joining these plans is your answer!
Take a look at Momentum Health Medical Aid
Are you on regular medication to treat a chronic illness - from diabetes to depression?
Medical schemes have to cover the costs related to the diagnosis, treatment and care of an emergency medical condition, a defined list of 270 diagnoses and a defined list of 27 chronic conditions.
Maybe you qualify for chronic medication benefits, where the scheme pay - without using your savings.
Ask your doctor to motivate for this and by completing a simple form, you could save yourself hundreds of rand a month!
Here is a medical scheme that offers lower rates depending upon where you source your chronic medicines.
Contributions differ if you get your medicine from any chemist, a network supplier or the state.
If you do not need chronic medicine, these are the plans for you!
Where a scheme is able to control provider costs - through linking them in a network and offering direct payments - your rate is cheaper.
Most medical schemes offer network provider plans and if you are happy with the networks, you can get good benefits for a reasonable cost!
Some network plan contributions are based upon your income and are the lowest cost medical scheme plans available. However, they can be restrictive in the benefits they offer, but do offer life-threatening and life-sustaining benefits for extremely good rates!
They are ideal if you need medical aid for pensioners, children who become adult dependents on your plan, students and those who earn low-incomes, but want access to private healthcare.
INGWE Medical Aid - offers an ANY hospital option as well!
KEYCARE Medical Aid - the most popular and largest plan in South Africa!
There are plans specifically designed for full-time students, offering excellent benefits at a really good price!
Moving students onto their own plan, which you can pay for, is first prize in reducing your overall cost!
Although they have smaller monthly contributions, they don’t compromise on quality cover!
Your child’s healthcare needs are covered but, at a much more affordable rate.
You do need to submit proof of full time study and a parent can pay the contribution.
A child aged 21 can no longer be listed as a child dependant on your scheme.
This means that their cost will increase substantially or even double!
Some schemes do offer child rate cover - for financially dependent children up to age 27, as long as they are unmarried and not earning more than the maximum social pension.
Is your child studying part-time, but earning an income?
Then s/he will become an adult dependant on your plan at an increased cost.
(Any income precludes them from joining a student plan.)
Why not consider they join their own income-related Network Plans (above), as the rate should be very competitive.
You can pay the contribution if needs be.
They allow access to private providers, have unlimited hospitalisation and mostly unlimited basic day-to-day benefits.
Is your child is working full-time, but earning an entry-level salary?
Your child will become an adult dependant on your plan at an increased cost, when they turn 21.
Again, consider the income-related plans (above) or investigate more affordable medical aid cover such as hospital plans with gap cover.
The premiums on these plans are lower than comprehensive plans, but they still cover the most important medical needs.
With both these plans, even if you keep on paying your child’s contribution, you should still end up saving hundreds each month!
We are living longer than ever before, so no matter how carefully your parents have planned for the future, you may have to assist them financially by assisting with medical cover.
Given that the elderly are more prone to chronic conditions and other age-related illnesses, healthcare can become very expensive.
Prescribed minimum benefits - conditions such as high blood pressure, type 2 diabetes or cholesterol become problems as we age. These conditions often require expensive, ongoing medication.
The government has legislated for prescribed minimum benefits (PMBs). This is a list of 270 conditions which, by law, even the most basic of medical schemes have to cover.
So regardless of what form of medical cover you and your parents choose, at least their chronic medication is paid for.
Or, make them a dependant on your plan. If you can prove dependency on you or your partner, they can join your plan.
However, if this is the first time your parents are joining a medical plan, or they have a long break in membership, they will be subject to a late-joiner fee, which will increase your cost.
They may also face waiting periods.
They have their own medical plan. If they are not earning high incomes, look at the income-related plans (above). The only concern may be access to network providers?
Again, you can pay the contribution.
They can also cover hospitalisation and dental care through the Best, Affordable Hospital Plan with Dental benefits!
This plan covers the 2 highest risk areas of their healthcare needs as they age. It will cover all in-hospital care, as well as PMBs.
Please AVOID Hospital cash-back plans!
The reality is many of us are going to have to contribute to our parents’ upkeep, so it’s worthwhile looking into medical scheme options, before it gets to the point where they really need it and your choices are limited.
I can resolve these concerns for you at no charge!
Yes, you pay what you are currently paying – nothing more.
I do need to be appointed as your broker, as this gives me and my team access to your problems.
I only deal with certain schemes, but can certainly stop your worry and frustration!
In a couple of days, I will confirm acceptance and we can quickly get onto your concerns.
Medical aid is a complicated product. We do need to have it, but we must fully understand what the benefits and limits are.
This is where we can help! We know these products... all the fine print.
And we can show you what cover you have!
I am a fully licenced and accredited broker with over 30-years of experience.
Do you experience unnecessary stress at year-end when the time comes to select your plan for the following year?
This is when you need help!
We work with medical schemes all day. I know the in's and out's of a good plan and can readily show you options to suit both your needs and pockets.
It is NOT always ideal to change medical plan.
You can get waiting periods joining a new scheme.
Rather investigate moving to a different plan, within your current scheme.
Again, appoint me and I'll help you make those decisions!
And I'll be here 24/7 to assist you!
If you want to change schemes, then let me assist you in a comprehensive analysis of a new plan for you.
And I can show you ideas to help you to reduce the cost of your medical aid.
We will offer you the BEST HELP FOR FREE!
Last update July 29, 2020
Medical Aid Authority Peter Pyburn.
South African rights reserved.