In return for paying a monthly amount – called a contribution – medical aid covers you financially for various medical expenses. Depending on the medical scheme plan you’re on, these can include in-hospital treatment as well as things like screenings for certain diseases, day-to-day expenses like medication or GP visits, and dental treatment.
Medical schemes usually require that you use their own network of hospitals and healthcare providers to be fully covered. If you use providers outside of the network, you may be liable for extra charges. This is the where the scheme pays claims at medical aid rates (100%) and providers can charge up to 500%.
A Top Up/Gap plan will pay any of these shortfalls for you.
If you have a history of hereditary chronic disease in your family - like high blood pressure, cholesterol or diabetes - you must consider a comprehensive plan with good chronic medicines benefits!
If you have existing or are expecting future health issues – that are NOT PMB conditions - then again, a comprehensive plan may be best for you.
If you are healthy then consider a hospital only plan and pay your own day-to-day costs.
They are more affordable, whilst protecting you against the real threat of not having a medical aid - hospitalisation!
Some even pay out of hospital dental costs along with Private hospitalisation!
Medical aid is an insurance that covers you for large and unexpected events which could financially ruin you.
It allows you to access the best treatment when you do need it and that cannot be under-estimated!
What do unlimited benefits actually mean?
In short, medical aid options that include unlimited benefits, whether it is for hospitalisation, ante-natal consultations or other medical treatments, allow you to make an unlimited number of claims according to the restrictions set out in your particular scheme. For example, if your option includes unlimited hospital cover and you fall victim to a car accident, you will be covered for all hospitalisation procedures regardless of the total costs involved. You may still, however, be liable to contribute towards each operation, depending on the specifics of your policy.
By contrast, instead of offering unlimited benefits, some medical aid providers offer schemes with an annual limit, meaning that they will only allow you to claim until you reach your capped amount. In a situation where you require medical attention but have exceeded your cap, you would be required to make any additional payments for yourself. Plans with unlimited benefits do not have such limitations.
Do I really need unlimited benefits?
In the event of an unexpected accident, you could require several operations which may well end up being incredibly costly. Emergency medical care can often cost in excess of R100 000. Should you require multiple operations in a short space of time, extensive medical care for your entire family or if there are complications from surgery, the bills can mount up quickly. Your time in hospital should be focused on recovering, not worrying about how you are going to pay your medical bills.
Here at Selfmed, we pride ourselves on the fact that every one of our medical aid plans includes unlimited benefits for hospitalisation. With any Selfmed medical aid plan, you can rest assured that you are covered throughout the entire year and up to any amount, regardless of previous claims.
MedBioWorld: one of the largest Internet sites for medical and biotechnology journals, associations, databases and other resources.
Council of Medical Schemes
Last update June 29, 2020
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Medical Aid Authority Peter Pyburn.
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