Good health - and the ability to quickly recover from ill-health - is the most important aspect of a successful life!
All too often, it is only when we are in an emergency room, that the true value of a medical aid becomes apparent!
That is when having a good medical aid removes a great deal of stress.
Being able to afford the best care - as fast as possible - is vital.
9 compelling reasons for joining a medical scheme in South Africa!
Why is that so important for me?
A medical scheme helps you to pay for your healthcare needs, such as nursing, surgery, dental work, medicine and hospital accommodation.
Unless you have large amounts of money available (at very short notice) you will be unable to get the best medical assistance in an emergency.
You will not be able to access private care and that can have severe healthcare consequences for you and your family!
You can have a car accident the next time you travel!
Or you can suffer a survivable heart attack whilst reading this!
How much do you think 6-weeks in intensive care will cost?
Do you have that money to spend?
And what if you have an emergency? Can you fund that cost - immediately?
If not, then you seriously need to consider joining a medical aid NOW!
Medical aid is seen as a grudge purchase - something that is expensive (and a waste of time if you claim little from it), but the longer you delay joining, the more expensive it becomes.
The basic design behind medical aid is one of risk-pooling - where a healthy member helps subsidise the expenses of the unfortunate, more sickly member. However, people have a dangerous attitude of "Why must I join when I am not going to need it?"
No one can predict what expensive health issues they may have later today! Emergency hospitalisation is not cheap! Then as you age, you are going to experience a higher need for medical services. That can be financially crippling without a medical aid to help pay costs.
So, the Medical Schemes Act protects the schemes, by allowing waiting periods and late-joiner penalties to be levied on new members who join later in life - only when they need help.
You can land up paying up to 75% per month more!
When you apply to join a medical plan, you complete an application. That is then underwritten by the scheme.
That scheme then can add Waiting Periods, the length of which depend upon your health and how long you’ve been without medical aid cover. They can range from a 3-month general waiting period to a 12-month condition-specific waiting period.
There are also, monthly Late Joiner Penalties to consider. The older you are when joining a medical scheme, the more severe the late joiner penalty. The penalty depends on how many years of past medical membership you have.
So, the sooner you join a medical scheme, the faster any potential waiting period can begin. And the lower lower any possible late penalty will be.
To find a medical scheme with no waiting period is very unlikely.
You can never be too young or too healthy to join a scheme!
Joining a Medical scheme is really not that difficult!
All it needs is a little research and help from someone who knows the products... and that is what we offer you.
Please read ...How to join a medical aid.
Yes, we offer help - at NO CHARGE! Make joining a plan simple and easy.
1. Join a good plan before any serious illness strikes.
Look ahead 5-years to try and assess what cover you’re likely to need, track your health history and consider any genetic factors that may play a role.
Ask me for independent advice to help you choose the right medical scheme package.
If you suffer a life-changing event (from pregnancy to cancer) you can IMMEDIATELY upgrade your plan.
Now you can join a cheaper plan, safe in the knowledge that, if you need better benefits for such events, you can get them!
2. Don't choose a plan purely on cost!
Identify what benefits you need, then look for plans that best meet those needs. Be realistic about the state of your health and don’t bank on the invincibility of youth, or your current state of good health lasting forever.
Compare costs and trim your plan to your budget. You must get quotes before joining a scheme and this is not always an easy or understandable process!
Remember, pay cheap premiums and the chances are you are joining an unsustainable plan with equally cheap benefits!
You could land up in hospital, facing huge costs that your plan does not pay!
When it comes to choosing an affordable medical aid, we try to make this easy, simple and as quick as possible for you. USE US!
You run a real risk when “cutting out the middleman!” Especially when it costs you nothing extra!
3. What about exclusions, limits and implications of a scheme’s network of doctors?
A medical aid may exclude you from a specified condition for a period of no longer than 12 months. This is also known as a condition-specific waiting period.
However, if you are not honest when you apply to join a plan - by disclosing your full medical information - that scheme can repudiate your claim and not pay it, or worse, terminate your membership, permanently exclude you from ever joining them again and take legal action against you.
If your plan does not cover a medical procedure or service, (as stated in the plan rules), then you cannot claim for it. This is especially so with lower cost/lower benefit plans.
If you join a network plan - where you use linked providers - and you use a service outside of those networks, you will be liable for a co-payment for any amounts charged in excess of what the plan pays.
They may also not pay anything at all!
This makes it vital that you have read and understand your plan rules.
We will provide the information you need if you use our services – all you need to do is READ IT!
It is in writing, so there is no misunderstanding. And you can see that discussion ….anytime!
We are just an email away and we will respond far more quickly than getting a broker appointment!
4. Avoid Hospital Cash Plans
They 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.
Get 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.
A far more secure form of healthcare cover!
5. What about wellness and loyalty programmes?
These should not be the reason you are buying a medical aid!
It costs money to belong and accumulate benefits with these programmes!
A free rewards programme is worth what you pay for it!
However, some wellness plans are worth it and if you are dedicated enough to use them properly, you can get rewards.
The biggest return is the incentive to get and keep healthy. That alone is priceless!
Again, talk to me for help in making a decision.
If you do your research properly and get professional help, you can choose a plan to best suit your needs.
Then you won’t be disappointed when claiming, because your expectations will be met.
Because a full medical aid is so expensive, many members are looking for alternative forms of cover.
And the best place to start, is to address your 2 greatest medical financial threats ... private hospitalisation and dental costs.
You can choose to join either a medical aid hospital only plan or an insurance-based plan.
The Difference Between A Medical Aid Hospital Plan and Hospital Cash Insurance.
|Medical Aid Hospital Plan.||Hospital Insurance Plan|
|Governed by the Medical Aid Act||Governed by the Short-term Insurance Act|
|Full PMB cover||Nothing|
|Unlimited, high in-hospital sub limits||Low rand amounts per day in hospital|
|Provides mostly unlimited in-hospital cover, as well as stated benefits for day-to-day medical expenses. In certain instances there may be an overall annual limit, which is generally around R1 million per annum||Provides cover at fixed or stated amounts of money for every day that you are hospitalised.|
|Includes both hospital plans (predominantly in-hospital cover) and full cover plans (provide in-hospital cover and stated day-to-day benefits).|
Hospital accounts are usually settled in full and related accounts (doctors and other providers) are settled at the particular scheme tariff.
In-hospital cover only.
|Hospital benefits range according to the plan. Private hospitals may be used, or in other plans only networks may be used.||The daily benefit remains the same, whether a private or public hospital is used.|
|Accepted by private hospitals, so no deposit required||Only emergency accidents | Guarantee of payment needed before admission|
|Pre-existing medical conditions may be excluded for 3 and/or 12 months.|
With no waiting periods, benefits start once you are admitted to hospital.
|Most plans will cover hospitalisation due to accident from the start date.|
Depending on your plan, cover for hospitalisation due to illness starts after either 6 or 12 months.
Benefits are payable after a certain number of days spent in hospital – usually after 2 days.
|Yes for PM’s||No to PM’s|
|Comprehensive major medical cover||Rand amount or number of annual events|
|Comprehensive dread disease cover||Rand amount or number of annual events|
|27 Chronic conditions covered||Nothing|
|Payment usually directly to the hospital and providers.||Payment directly to the member, who must settle accounts.|
|Hospital cover usually unlimited.||Hospital cover usually for a fixed limit, which may not be sufficient for extended hospitalisation.|
|Any age allowed to join||Limited ages.|
|Medical schemes are non-profit organisations.||Short-term insurers are for-profit companies.|
Medical Aid Hospital Plans cover your emergency or planned expenses in hospital. Costs like:
They are perfect for the healthy or younger member who has little need (and can self-fund) out of hospital benefits.
Hospital Cash Insurance plans are not medical aids.
They pay cash benefits according to the policy schedule, normally a set amount and after waiting periods which totally exclude claims for short hospitalisation stays.
This payment may not cover your expenses, leaving you with a shortfall.
Gap/Top up plans do not work with hospital insurance, so you will have to pay.
New regulations state that pay-outs are limited to R3 000 daily, up to a maximum of R20 000 per insured life, a year, per hospital stay.
Seriously! A caesarean birth costs around R30 000 and far more if complications occur!
The money is paid to the policy owner, not the medical provider and that is why hospitals will demand deposits on admission.
Because they are low cost, many people choose these plans over a medical aid hospital plan.
BUT, the limited daily amounts they pay are way below the medical expenses incurred while in private hospital!
Hospital insurance companies are ‘for profit’ unlike medical schemes, who are ‘not for profit’. So any profit made is kept by them NOT put back into company to reduce costs.
That is why we do not recommend them at all.
They would be ideal for low income earners (who cannot afford a medical aid or hospital plan) or when used along with medical aid/hospital plan as an income replacement - due to being hospitalised.
USE US - YOU HAVE NOTHING TO LOSE!!
25+ years in medical aid .... we know how it works!!
Medical schemes pay in-hospital costs at different rates and if you use private providers, you could have a claim shortfall.
Schemes are increasingly adding procedure co-payments as well.
What can you do to address this threat?
If you can use providers who have a payment agreement with a medical scheme, they will charge what the plan pays. So, you should never experience an in-hospital claim shortfall.
Every medical scheme member should have an insurance-based Top up plan.
It is a vital part of having full in-hospital cover!
These are totally separate products to a medical scheme and will work with any medical aid.
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Last update: April 6, 2021
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Medical Aid Authority Peter Pyburn.
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