However, please try to consider other areas of cost saving before you consider changing your medical scheme.
If you still need to change your medical cover, your options are as follows:
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!
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!
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 premium 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 premium will - over a year - add up to more than the savings in a medical aid!
Take the “saved” premium – over a comprehensive plan premium and save that 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 in a medical aid savings account as you wish! You can’t get to it for a holiday, or for your retirement. In fact, you can only get it 6-months after you leave the scheme!
Yet it is your money. You “saved” it as part of your monthly contribution. Is that fair? And they only pay you bank interest on your savings.
Surely you could do better investing your own savings. Of course you can!
It 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 that 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 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 aid, with essential dentistry benefits and no network providers!
Unbeatable benefits and cost!
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 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.
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 that benefit is higher than the actual expenses you have and it would be cheaper to pay those costs (after your savings are used) yourself?
You may be young and/or healthy and only need a fund for the unexpected.
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. Some providers 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 aid. 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.
Most medical schemes place a portion of your monthly contribution in a medical savings account, which is used to pay for day-to-day benefits.
Now, for the first time ever, FlexiFED allows you to begin paying for day-to-day benefits only when you need 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! With these plans, your premium 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. or 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?
And 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 - paying for savings, when you don't need them!
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 aid rate!
So, 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.
Schemes who contract with providers can control costs. If you use these providers (chemists, GP, specialist or hospital networks), you can get discounted premiums -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 lower premiums and you should investigate them.
If the providers are acceptable, then joining these plans is your answer!
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!
If you do not need chronic medicine, these are the plans for you!
Most medical schemes offer network provider plans and if you are happy with the networks, you can get good benefits for a reasonable cost!
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 medical aid, students and those who earn low-incomes, but want access to private healthcare.
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.
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.
Consider their own income-related Network Plans (above), as the premium 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.
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 premiums, you should still end up saving hundreds each month!
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.
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 aid, or they have a long break in membership, they will be subject to a late-joiner fee, which will increase your premium.
They may also face waiting periods.
They have their own medical aid plan. If they are not earning high incomes, look at the income-related plans (above). The only concern may be access to network providers?
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!
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 aids.
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.
Last update: January 21, 2020
Medical Aid Authority Peter Pyburn.
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