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Healthcare is expensive, but so necessary if you want to be able to immediately afford the finest medical care. And that is key to a fast and effective recovery from accidents and illnesses that require care.
In order to find and join the best plan for your needs and budget, you must have a basic idea of what types plans are on offer and how they are structured to help you meet the risk of high medical costs.
Our need for medical care can be divided into:
There are various ways to cover out of hospital expenses and it is here where you can save premiums by choosing the type of plan you want to join. In an attempt to fight the high costs of healthcare - but still have protection against high private care expenses - many members are joining only in hospital benefit plans and self-funding day-to-day costs.
Some plans offer additional benefits like GP or dentistry, so you do not use your limited set benefits for these treatments.
This prevents a situation of having used all the benefits on one condition, with nothing left for other healthcare needs - as can happen with saving plans. These plans use a form of cross-subsidisation to manage claims.
These plans are suitable for members who have a high need of medical services on a monthly basis. GP, medicine, dental etc. visits.
Advantages: If you use one benefit, it does not affect the others. You know exactly what benefits you have at any time.
Disadvantages: Benefits do not roll over to your next year, so if you do not use them, you lose them. That is a waste of money!
You can only spend it your medical needs and there is no cross-subsidiatation amongst other members.
Fedhealth medical aid offer innovative and attractive ways of working these savings and you can save a great deal of premium with them!
Most plans offer a safety net (threshold benefit) should you have spent your savings and still need cover. Once your claims add up to a pre-determined amount, they pay further costs that year subject to some limits.
Genesis medical aid pays essential dental costs, so you don't use your savings on these claims!
These plans are suitable for healthy members who do not use a great deal of day-to-day medical services, but do want the security of knowing that if they do need funds for high claims, they have them.
If you have high dental or optometry needs (where sub-limits of a particular medical aid are insufficient) the ability to use more savings on certain costs is ideal.
Advantages: You have the discretion to spend your savings as you want and any unused amount is carried over to your next year.
strong>Disadvantages: You could spend your total savings on one claim and then have nothing for the rest of the year. Or, one family member could spend the entire savings, leaving the rest of the family without cover. You need self-discipline to effectively manage these plans.
There are also options that use the best of both Traditional and New Generation plans. They have both set benefits and savings all in one plan.
Some plans have premiums based on your level of income.
These 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!
These plans are ideal for pensioners, children who become adult dependants on your healthcare plan, students and those who earn low-incomes, but want access to private healthcare
They typically have no overall limit hospitalisation, excellent set benefit amounts or high savings for day-to-day needs and the highest number of chronic illnesses medications.
Comprehensive Plans are designed for those who have (or expect to have) high medical expenses or who want the security of knowing they are fully covered should ill health occur.
Members and families who want the security of knowing high medical costs associated with children are covered and the elderly, who have higher needs for medical treatments, are catered for.
They offer the best method of controlling medical aid costs, by "insuring " for the greatest medical financial risk we face - private hospitalisation - whilst you self-pay for your day-to-day costs.
They are recommended for those with a strict budget or healthy members who have little need for out of hospital cover.
Benefits include all planned and emergency, in hospital costs from admission to discharge. That includes ward and theatre fees (which are normally fully covered), anaesthetist and surgeon, pathology, physio and other providers.
Unless you are admitted immediately after casualty treatment, most plans do not cover casualty costs.
Here is a plan that does pay casualty ward costs, as well as 30 days post-hospital costs for certain treatments and allows an upgrade to a higher plan if you suffer a defined life-changing event!
There is a hospital plan that will pay essential dental costs as well, further reducing the risk of self-funding out of hospital costs!
Plans may also offer specific maternity, chronic illness programmes, screening and preventative care benefits.
Some plans offer unlimited cover at network hospitals.
Increasingly, plans also have procedure co-payments, which you have to fund.
You are strongly advised to consider a GAP or top-up insurance plan to address these threats.
This separate insurance plan will cover most in-hospital claim shortfalls and scheme co-payments.
By adding a top-up plan you can improve your medical aid benefits, so-much-so, that you can even consider joining a lower cost/benefit plan - with a lower premium - and still have an excellent, no risk medical aid for virtually the same premium as the higher medical aid!
Why not invest in a hospital plan and create your own day-to-day savings fund... open a bank savings account, or use your home as an access bond – pay extra into it and use that for day-to-day expenses?
All in-hospital costs are covered as with hospital plans. There are two ways out of hospital claims are paid:
An example of a scheme with hospital and defined day-to-day benefit plans.
Example of a hospital and saving fund plan.
In fact Discovery Health's KeyCare Plan has more members than most total medical aids!
The plans offer hospital, day-to-day and chronic illness cover using a network of providers. They can include day clinics, maternity, HIV, cancer, diabetes and mental health programmes, preventative and screening and even home-based care benefits.
Momentum Health's Ingwe plan covers the use of any hospital, or a network of hospitals for a further premium discount, or state hospitals with the lowest of all premiums.
These plans offer life-threatening (heart attack, car accident etc.) and life-sustaining (cancer, kidney etc.) benefits for a very affordable premium, which you do need to prove!
Full time students also have access to medical aid.
Benefits include unlimited hospitalisation at any hospital (including casualty), mostly unlimited basic day-to-day cover with network providers. Dental and optical benefits are included.
This medical aid is recognised by Home Affairs for study visas that International students require. And we can get you your certificate in a very short time!
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You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.
Medical aid pays healthcare costs.
What if a disability STOPS your income?
Last update: July 26, 2021
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Medical Aid Broker Peter Pyburn.
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