5 things to keep in mind when choosing a medical aid

Many people consider a medical aid a non-essential ”nice-to-have” that is reserved for the very wealthy. That is, until they need a medical scheme to cover the hefty costs associated with private medical care, procedures, examinations, dental procedures, spectacles and eye exams.

The list of what medical aids provide for is a long one, and unfortunately many of these medical procedures can be quite costly – certainly not ideal for people who don’t consider themselves wealthy enough to afford a medical aid in the first place.

There are in excess of 80 medical aid and hospital plan providers currently doing business in South Africa, and their respective monthly premiums tend to vary rather wildly, catering for a range of income groups. With that being said, opting for the cheapest plan is not always responsible – even if there is probably a plan available that caters for your individual medical needs at a monthly premium that you can afford.

Before signing on the dotted line and setting up a debit order, prospective medical aid members should keep 5 things in mind.

1. Take a thorough look at your finances: The rule of thumb is that your monthly contribution towards your medical aid should not exceed 10% of your monthly income. Take a look at your monthly budget and gauge whether you would, hypothetically, be able to contribute 10% of your monthly income towards a medical aid, taking your current expenses and budget into consideration.

2. Assess your needs: Consider you and your family’s medical history (chronic conditions, the amount of annual doctor’s, dentist’s and optician’s visits) to establish what kind of cover you’ll need in terms of a medical aid or hospital plan. Keep in mind that there is always the possibility of needing a medical aid or hospital plan for those instances that you hadn’t planned for or expected.

3. Medical aid vs. hospital plan: If you are able to pay out of pocket for annual medical exams and doctor’s visits in general, but do not have the financial capacity to afford a monthly medical aid premium, a hospital plan might be better suited for the needs of you and your dependants.

4. Carefully consider the benefits and exclusions of each plan: Many a person has had the unpleasant surprise of finding out that their medical aid or hospital plan does not cover certain procedures or conditions. Once you have a few providers in mind, go over the benefits and exclusions included in each plan with a fine-tooth comb, and make sure of the day-to-day limits, the amount available in a Medical Savings Account (MSA) per year, the rates offered for hospital stays (many private hospitals do not charge medical scheme rates), co-payments, annual hospital limits, HIV cover, as well as cover for pre-existing conditions. Speak to your financial adviser about what might be the best option for you.

Have a look at a scheme’s payment record: Medical professionals might not be keen to accept payments from certain medical schemes, due to experiencing delays and other problems with payouts in the past. Ring up your GP and find out which medical schemes they’ve had these issues with, and avoid these altogether.

A medical aid is an insurance plan for your health, and just like your vehicle insurance, it’s something you hope you’ll never need. However, when your health does hit a pothole, you’ll want financial back up for peace of mind. The financial advisers at Key Wealth are experts in the realm of medical schemes, and also provide a range of other financial services.

If you’re looking for a new medical scheme, or if you’d just like to revise your current products as a part of you end-of-the-year financial review, get in touch with us today.

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