Are you, like so many medical aid members, struggling to meet the cost of your medical aid plan?

Maybe you feel you can't afford to keep your medical aid?

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!
I can help you FOR FREE!

Your biggest financial risk is the cost of private hospitalisation. You cannot compromise on this!
The next highest expense is normally in and out of hospital dentistry. Again effective cover is a must!
Lastly doctor, chemist and glasses, which you may be able to self-fund through your own savings plan.

Your answer may be to consider joining a lower benefit and cheaper plan?
Remember, the greater the benefits of a plan, the higher the costs. Read this...
So, consider cheaper options that have a smaller medical savings plan 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 medical aid contribution.
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:
- look at a cheaper plan (possibly a hospital only plan).
- reduce your number of dependants,. by placing them on their own plans.
- change to a cheaper network or income-related plan.
- opt out completely and use state healthcare facilities (not recommended!)


nurse

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! These are where unexpected high expenses will happen. Most GP and chemist bills can be paid, but 6-week in intensive care or wisdom teeth removal can be extremely expensive! You need to have medical cover for these threats!

Consider a private hospital plan with dental benefits, because it will pay:

  • Hospital and related accounts (e.g. theatre costs, x-rays, MRI and CT scans, pathology, physiotherapy, blood transfusion, medicines, etc.)

  • General ward, intensive and high care wards of any private hospital, day clinic or the recovery room charges of an unattached operating theatre!

  • in-hospital doctors and specialists covered!

  • Surgical procedures done in doctors’ rooms!

  • Cancer, Stroke, Organ transplant cover!

  • strong>Chronic medication!

  • Emergency evacuation!

  • AND basic, as well as some enhanced dentistry benefits all paid by the medical plan!
  • You address your 2 greatest medical finance risks AND can use any provider you want - all in one plan!

    Many happy medical scheme members are doing just this! They feel secure in knowing they are protected from these high costs.
    Medical schemes offer plans that cover in-hospital costs only, but they are not the same!

    There is a plan that offers unlimited in-hospital AND certain out-of-hospital dental benefits!
    Check it as you will not be disappointed!

    Add the GAP COVER and TOP UP PLAN and you will have unlimited private hospital cover, paying up to 5 times medical scheme rates, with dentistry benefits and no network providers!
    unbeatable benefits and cost!

    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!
    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 it!

    Why not take the “saved” premium – over a comprehensive plan premium and save that yourself.

    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.

    You can use it as you wish. 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 savings.
    Of course you can!

    Create a savings plan in a bank account or with a medical debit card.
    Add extra to your access bond as a good alternative! In this way, you reduce the capital loan of your bond and can save immense interest, which will far outweigh any return you get with a medical scheme savings account! And you have access to a large savings fund!

    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.

    hospital

    2. Hospital cover with day-to-day savings.

    Plans that cover hospitalisation and chronic benefits and include day-to-day treatments through the use of a savings 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.

    The savings account is simply a fund of your own money, created from an added amount onto 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 draw 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 reduce the amount of the savings fund you feel you need - you reduce could your premium by that savings portion! Medical schemes do offer few plans with different savings contributions to meet these member preferences and one scheme even allows you to design the savings you want!

    You may have a safety net, should you use up your savings. These plans are very expensive and you need to carefully investigate if you really are using that threshold benefit. Most members only use threshold benefits late in the year, so they do not use the benefit fully - yet have paid for it since the start of that year! 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?

    If you take a Top Up plan, you could look at a plan that pays at medical aid rates (not the more expensive 2 or 3 times medical aid rates plan) and has a small savings.
    The Top Up will ensure you have private rate cover for those unexpected costs, the lower plan contribution will help pay that Top Up cost - all whilst managing most of your normal day-to-day costs yourself!


    copayment

    3. Hospital cover with limited day-to-day benefits.

    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?

    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:

    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 your saving … 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!

    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 copayment?
    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!


    gap top up

    4. Something you must consider - when considering only a hospital plan - is GAP or TOP UP cover.

    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 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 copayments for certain in-hospital procedures. Again, more expensive plans have fewer copayments.

    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.

    top up

    Or, better, buy a Top Up/Gap plan that will pay any in-hospital shortfall and copayment.

    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!

    The Best Gap/Top Up plan available.


    savings

    5. Use Preferred Provider Networks to get premium discounts of up to 35%!

    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!

    Momentum Health Medical Aid


    chronic

    6. Chronic Medicines.

    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. Premiums 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!


    nurse

    7. Move to a network plan.

    Where a scheme is able to control provider costs - through linking them in a network and offering direct payments - your premium 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!

    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.

    INGWE Medical Aid - offers an ANY hospital option as well!

    KEYCARE Medical Aid - the most popular and largest plan in South Africa!


    students

    8. Students.

    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 premium!

    Although they have smaller monthly premiums, they don’t compromise on quality cover! Your child’s healthcare needs are covered but, at a much more affordable rate.


    young adult

    9. Children older than 21 years of age.

    A child aged 21 can no longer be listed as a child dependant on your scheme.
    This means that their premium 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 medical aid at an increased premium. (Any income precludes them from joining a student plan.)
    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.

    Is your child is working full-time, but earning an entry-level salary?
    Your child will become an adult dependant on your medical aid at an increased premium, 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 premiums, you should still end up saving hundreds each month!


    retiree

    10. Your Parents as Dependents.

    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 aid. 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.

    help with medical aids11. Do you want help with your medical aid - for free?
    Yes, at no charge!

  • Are you struggling to get answers from your broker or scheme?
  • Do you have concerns over what benefits you may not be aware of?
  • Do you have queries and complaints that are never answered?
  • Do you never receive a promised follow-up?
  • 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 medical appointmentdeal with certain schemes.
    Stop that worry and frustration.
    Complete the appointment and return to me.

    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 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.

    The best advice is to talk to us.
    Let us investigate and present the various options open to you.

    We will offer you the BEST HELP FOR FREE!

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