These ideas may help you prevent having to terminate your valuable cover.
The Covid-19 pandemic has made us realise just how important it is to be a member of some sort of medical insurance plan – whether that is a simple hospital only or fully comprehensive plan.
Living in South Africa, you have no choice but to have some sort of healthcare. The state medical system is not an option – unless you have no option but to use it.
Life-saving treatment in private care will cost far more than your monthly medical aid premium!
You are not bullet-proof. Don’t think you are never going to face high medical expenses. Accidents or illness can and does happen – to anyone of any age!
But if you have no medical aid, they will stabilise you then transfer you to a state facility. Not the best situation for anyone!
They may also not admit you without a substantial cash deposit being paid – before any treatment is given!
This can be absolutely devastating to your financial circumstances.
Private healthcare is very expensive and with no “medical insurance” plan, self-funding private hospitalisation, (even for a single operation) will quickly exhaust your savings.
Even if you are unconscious and it has been established that you belong to a medical aid, you will be taken to a private hospital. Just think what will happen if you are not a healthcare member!
Please remember that state care still requires payment of fees, depending on what they believe you can afford!
You still land up paying for treatment, but in an overcrowded and understaffed hospital with little prospect of getting the care you may desperately need. Again, not ideal!
A simple procedure like the removal of wisdom teeth (with a few hours in hospital) can cost upwards of R13 000!
Suffering from COVID-19 greatly increases the risk of complications with co-morbidities, or the coexistence of two or more diseases or disorders you may have – and not know that you do!
Without medical aid, all your medical expenses, especially those at a private facility, will be for your own account. And this at a time where you’re at risk of falling seriously ill.
However, COVID-19 is classified as a Prescribed Minimum Benefit (PMB), so a medical scheme has to cover costs related to your diagnosis, treatment and care (consultations, medication and hospitalisation).
During the pandemic, large numbers of patients have been avoiding necessary hospital visits, fearing catching the virus. This delayed treatment can only cause medical complications and fatalities, unrelated to COVID-19. And in the future, these patients will have to return to the hospital system, further stressing the healthcare system.
Joining a medical aid will protect you and your family from having to pay high, unexpected medical costs yourself.
It ensures that you can get the best treatment quickly and that is vital for any recovery!
Terminating your medical aid is the worst decision you can take.
The best idea is to move to a lower, more affordable plan. or “buying-down”.
Medical aids offer 3 main areas of cover: in hospital, day-to-day and chronic illness benefits. That said, joining an expensive medial aid plan that has a day-to-day savings account for your day-to-day out or out of hospital expenses, may not necessarily equal better benefits!
We join a medical aid to ensure peace of mind and access to funds for the “big ticket” private healthcare costs.
Hospitalisation costs may run into hundreds of thousands or even millions of Rand.
Always make sure that you have sufficient risk (i.e. hospital and related costs) cover in place. Day-to-day expenses can be managed separately on an as-and-when basis.
A period in a hospital can cost a fortune, so we need - at least - a plan that will cover that risk.
Most medical aids offer these plans.
Here we are ONLY talking to medical aid in-hospital benefit plans. Not hospital plans as these are insurance products, not bound by the same rules medical schemes have to meet. They pay fixed cash benefits and can be extremely restrictive when claiming - very unlikely to meet more than a small fraction of your actual costs.
Join an in-hospital only medical plan because, claims are determined according to the actual healthcare expenses you face and not on a pre-agreed, daily cash sum which can never accurately protect you from unknown costs!
A far more secure form of healthcare cover!
Medical scheme in-hospital only plans cost less because they only pay for costs related to in-hospital treatment, including surgery, ward fees and/or specialist fees.
You pay all your day-to-day costs like GP consultations, physiotherapist, medicines and glasses on an as-and-when basis.
This is not too great a risk, as we have never heard of a member going bankrupt over a chemist bill. But a family spending 2 weeks in intensive care … well, that is another story altogether!
However, private providers like doctors and specialists can charge what they like.
And these fees can be up to 5 times what a medical aid pays!
Different medical aid plans will pay at 100%, 200%, or even 300% of these fees – the higher the payment, the higher your premium!
Shortfalls are almost guaranteed to occur with these providers and you should seriously consider a Gap or Top Up plan which will pay any shortfall or procedure co-payment.
And if you do join a Gap plan, you can then consider joining a “lower” benefit hospital plan with a lower premium, safe in the knowledge that you will have cover. In some instances, the “saved” premium of the lower hospital plan will pay the Gap plan contribution!
Genesis is a scheme that really understands the financial pressure that lockdown has brought to South Africans.
They understand the need for reducing medical aid costs and the advantages of joining an affordable hospital plan.
So, for the ninth consecutive year,they have the lowest average contribution increase of all open medical schemes in South Africa!
They posted a 4,9% average increase for 2021.
In the most recent GTC Healthcare Consulting Medical Aid Survey, the Private Choice hospital plan received a 95% score and was rated as one of the best hospital plan benefit options in South Africa!
You have full choice when choosing your preferred hospital, doctor, or medical specialist and have unlimited in-hospital cover.
You are not forced to seek treatment in network hospitals, nor required to make use of network medical practitioners.
Hospital accounts, including treatment for PMBs, will usually be paid in full and in private hospitals, the charges of attending doctors/specialists and other healthcare service providers, even for PMBs, will be reimbursed at 100% or 200% of the Scheme Tariff, depending which plan you join.
Genesis is able to boast of a very high claims paying ability putting giving you the security that your claims will be paid. They are very solvent!
Offering comprehensive, no overall annual limit in-hospital and chronic illness cover on all plans, they give you the option of using any hospital or listed private hospitals.
They also offer discounted premiums depending upon your choice of any or listed hospitals or where you source any chronic medication you may require.
You have a choice of using any doctor or chemist, listed providers or state facilities with the greatest discounted premium (choose this option the plan if you have no chronic needs).
All Fedhealth plans are essentially unlimited hospital plans, but with the OPTION of using day-to-day savings if you really need them.
And only repaying those savings WHEN YOU SPEND THEM!
This is unique and revolutionary and gives you full control over how you use and pay for your medical aid!
Most medical aid savings accounts are really a compulsory loan, forcing you to pay for out of hospital benefits – even if you do not use them! They add an amount to your monthly premium – every month - to repay the loan. That is not right.
Fedhealth gives you full control over your savings. You only pay for what you use. So, when you do not use the savings, your premium remains lower, as you are not repaying a savings fund “loan”.
When you do spend your savings, the amount you use is repaid over the next 12-months – interest-free!
One-twelfth of what you spend is added to your premium till the “loan” is repaid.
And because these savings are not regulated as part of the medical aid, the amounts are higher than standard medical aid saving accounts.
If you don’t want the responsibility of controlling these savings and want plans that work like other schemes, (where savings are available and no added premium is done when spending them) Fedhealth offers identical plans, but with traditional saving accounts.
Premiums from R 2,088 with R 3,900 savings.
2020 asked a lot from you. Now it’s your time to get answers.
ASK “WHY” other medical schemes make you take a more expensive option “just in case”, instead of letting you upgrade if something actually happens?
Then ask yourself why you haven’t switched to Fedhealth yet?
It is a compulsory loan you must pay – even if you seldom (if at all) use it.
Because these monies need to be easily available, you need to consider specific products like:
This change will immediately save you considerable premiums!
As we have stated, high premiums or comprehensive medical aid plans do not always ensure better benefits.
Yes, some comprehensive plans do have added benefits like extended chronic illness conditions, biological drugs, unlimited cancer cover, etc..
Downgrading your plan in order to reduce your premium can be a risk, especially if you and your family members suffer from ill health, have a family history of illness, or suffer from or may be at risk of a chronic illness.
A lower benefit plan may leave your family without adequate medical cover, particularly with an unforeseen medical event. You may have to self-fund for a number of incurred expenses.
Your expectations with a lower benefit (lower premium) plan, will have to reduce!
Sometimes, upgrading your plan may be a wise move. Although it does cost more, you will have greater peace of mind in uncertain times, knowing that your medical needs will be taken care of - especially when you have a growing or aging family.
However, because they have lower premiums, they have a number of restrictions - like no specialised dentistry or joint replacement benefits. A number of them also require the use of state hospitals, so you need to fully understand how they work.
We are here to help you, often at no cost, every step of the way!
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Last update: April 6, 2021
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Medical Aid Authority Peter Pyburn.
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