7 Tips to Pick a Medical Aid Plan Just Right for You

A medical aid plan is one of the most important investments you can make to provide for your health now and well into your old age. There are a plethora of medical aid schemes, however, and even more types of plans to boggle the mind and make it difficult to choose a plan that meets your particular requirements.

Here are 7 top tips to help you make up your mind

  • Understand the types of plans available

There are different types of plans that provide different levels of cover, and which suit different budgets.

A hospital plan is the most basic plan available. It covers in-hospital treatment, but there are limits which vary from scheme to scheme. For instance, some schemes have a network of pre-approved medical facilities, so you’re only covered if you go to certain hospitals. Some schemes require a co-payment if you go to a hospital not on the list – often the co-payment is significant.

General cover is a step up from a hospital plan. It covers in-hospital and out-of-hospital benefits. There are also limits to the cover available, so you need to think about your needs before selecting general cover from a scheme. Some schemes have a pre-approved network of medical facilities and medical care providers, while others have free access to any hospital and doctor, etc.

Comprehensive cover is the best of the bunch. It covers a broad range of in-hospital and out-of-hospital benefits, including specialists, anaesthetists, optometry, radiology, chronic medication, and some complementary treatment, including physiotherapy and chiropractic.

  • Consider your budget

This is much more than just looking at the premium and factoring it into your monthly expenses. You need to look at co-payments, especially for chronic medication for conditions such as asthma, depression, and cancer. It’s important if you have one or more children on chronic meds. Co-payments can add up pretty quickly if you’re not careful.

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You also need to consider annual increases. Sometimes the increase in the premium is bigger than the increase in your salary. Will you still be able to keep up with the premiums if this continues for a year or more?

  • Figure out your medical needs now and into the future

This applies to your current state of health, as well as the health of your dependents, including partners and children. Perhaps you have dodgy knees from years of road running. Currently, you don’t need anything beyond the odd anti-inflammatory, but you know that a knee replacement is on the cards. Will your plan cover the replacement, the anaesthetist, physiotherapy, and equipment you’ll need during recovery and rehabilitation?

Perhaps heart disease runs in your family. Currently, you are fit and healthy, but it could go pear-shaped down the line. Will you plan to cover surgery and chronic medication thereafter?

You also need to play it safe and plan for the unexpected. For example, will your plan cover treatment for your entire family if you’re involved in a vehicle collision?

It’s best to sit down with your family and make as comprehensive a list as possible of current and future health needs.

  • Research the scheme’s reputation for customer service, payment, and response time.

The internet is a blessing when it comes to sussing out a company’s reputation. Sites like Hello Peter are a great source of information based on people’s personal experiences. Reviews can be positive or negative so it’s possible to get a (relatively) balanced picture.

Social media is also a great way to see how schemes respond on a case-by-case basis. People tend not to hold back on Facebook or Twitter, but it’s worth remembering that people are more likely to complain about service than recommend a company. A Google search may present a more balanced selection of reviews.

  • Look into gap cover
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It’s impossible to get away from limits in your cover, especially if you require expensive and extensive surgery or treatment with a significant recovery and rehabilitation period. This is when gap cover literally steps in to close the gap. It’s a separate medical insurance product that pays the difference between the actual cost of treatment and the sum paid by your medical aid plan.

It’s a financial safety net so that you don’t have to worry about how you’re going to come up with tens or even hundreds of thousands of dollars to pay for life-saving surgery.

  • Buy sooner rather than later

The earlier you start with medical insurance the more cost-effective it is and, in some cases, the more comprehensive the cover. For instance, if you put off buying medical aid until you’re in your mid-fifties you may already be receiving treatment for irritable bowel syndrome or you may have a heart condition and have already had bypass surgery. These are considered pre-existing conditions and the scheme may either not cover those conditions at all, or they will only cover a portion of the claims, leaving you with an enormous co-payment.

If you wait too long to get medical aid, your entry level will be higher than if you start young. This is purely because you will likely have age-related conditions that are already expensive to treat. Your premiums will be higher than if you started young. It’s called a ‘late joiner penalty’ and it can kick in when you’re still only 35 years old. Depending on the scheme and on your age, your premiums can be 25% to 75% higher than if you started young.

  • See an independent broker
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If all of this is too much – and it can be with research, unwrapping jargon, deciphering exclusions, co-payments, and actual benefits – then talk to an independent broker. Independent brokers are not affiliated to any medical aid scheme. They are not biased in any way and will do all the grunt work for you. They translate all the medical-speak, breakdown costs and benefits, and can show you comparisons between different schemes. They answer your questions so that you can make an informed decision about what plan is best for you and your family.