Am I insured for the unexpected?
The primary goal of medical cover is to insure those major, unexpected medical events such as a car accident or the birth of a premature baby. You may not have had a major claim in several years, but when the major events occur, it can run into tens, if not hundreds of thousands of rands.
Even if you are fit and healthy, make sure you have good hospital cover and make sure you understand what that cover provides.
If the option you are on has a limit on how much they will pay out to specialists, consider taking out Medical Gap Cover, which will pay the difference between the medical bill and the amount paid by your medical scheme.
What rate does the scheme pay GPs, specialists, hospitals and other healthcare providers?
One of the main differences between options is the rate at which each one will pay the medical provider. If the option you are on only pays at 100% of the medical scheme rate, be aware that if your provider charges more than the medical scheme rate, you will be required to pay in the difference. You are entitled to request a quote from your medical provider before you undergo a procedure. This way you will know whether or not you will have to pay in an additional amount and can also negotiate with the provider.
Do I need extended chronic cover?
Prescribed Minimum Benefits (PMBs) are minimum benefits that by law must be provided to all medical scheme members. PMBs are a set of 270 medical conditions, including 27 chronic conditions. If you have a chronic condition, or have a family history of a chronic condition that is not covered by the PMBs, then consider taking a plan with extended benefits.
Some options also discount premiums if you choose to receive your chronic medication through a state hospital. If you do have a chronic condition, this is a good way to save on your medical scheme costs.
Planning on starting a family?
Upgrade your option in advance of planning to start your family, as there can be exclusions for maternity benefits if you sign up too late. In general, don’t leave signing up for medical cover until you really need it as you may face waiting periods or exclusions.
Do I need an Above Threshold Benefit?
An Above Threshold Benefit is a safety net that provides cover for your day-to-day expenses once your medical savings account has been depleted and you have reached a pre-determined threshold level. If you are young and healthy with no children you may not need the additional cover as you may never run out of medical savings or may not reach the threshold level. However, once you start a family you may find that you quickly reach the threshold level and the Above Threshold Benefit saves you a significant amount on medical bills, which you would have had to pay out of pocket.
Is my doctor on the network?
Options that have access to networks of doctors or hospitals are often able to offer more affordable medical cover that may better suit your pocket. Rather than view this as limiting your choice, look at it as saving you money while offering the best quality of care. Check what healthcare providers and facilities in your area are signed up with the particular medical scheme you are considering.
Some plans will pay for your GP consultations even after your medical savings have been depleted, as long as they are part of the GP network. For certain qualifying options, Liberty Medical Scheme pays for two additional consultations per family at any LMS Network GP from Risk once Savings are depleted or members are in the Self Payment Gap (SPG). Liberty Medical Scheme also has a Specialist Network that gives members on certain options access to affordable specialist services within a reasonable distance of where they live. |
