Johannesburg – About 9 million people belong to medical aid schemes. As each new year begins, members start with a clean slate, with new benefits and replenished savings.
However, across the industry, members often complain that their benefits seem to “run out” early on in the year.
If you manage your medical expenses correctly, you can avoid out-of-pocket expenses and limit the possibility of running out of benefits.
Here are eight tips from Lee Callakoppen, principal officer of Bonitas Medical Fund, on how to stretch your medical benefits to maximise value.
• Use DSPs or networks Medical schemes negotiate preferential rates with providers, known as dedicated service providers, who have partnered with them.
This allows schemes to ensure that members get the best quality services at the most cost-effective rate so that benefits are optimised and the scheme at large is sustainable.
Using network doctors is an invaluable tool to make your medical aid last longer because it means you won’t be charged more than the negotiated amount.
• Ask your pharmacist Buy over-the-counter medicine to treat less serious ailments and always, where possible, use generic medicine that has the same active ingredient, strength and dosage as the original brands and are just as effective.
Pharmacists are able to provide medical advice on rashes, colds or illnesses that are not severe. Simply ask.
• Managed care benefits Some schemes offer programmes to help you manage severe chronic conditions such as cancer, diabetes, HIV/ Aids and back and neck problems.
These programmes are usually covered from the risk portion of your medical contribution and are not funded from your savings account.
They help you to use benefits to maximum advantage while ensuring you receive quality care by using specific providers.
Other benefits – such as maternity consultations, wellness benefits, preventative care and dentistry – are also paid from the risk portion by some schemes.
This gives you more value for money. Carefully read through what your plan offers and choose wisely to make sure you find the right plan to suit your specific healthcare needs.
• Go virtual Look out for telemedicine or virtual consultation options that are cheaper. A doctor will engage with you in a virtual video consultation on any medical issue and advise you on the most clinically appropriate steps for further care.
• Be aware of consulting after hours In an emergency, one has no choice but be aware that after-hours consultations are expensive.
• Know the facts If you do need to be hospitalised and it’s not an emergency, ensure that the healthcare practitioner is on your medical aid’s designated service provider (DSP) list.
Talk to your doctor to find out what they will charge and compare this to what your scheme will cover.
7. PMBs If you suffer from a prescribed minimum benefit condition, understand what benefits are provided and use the service of a DSP to ensure your claims are paid from risk rather than from your medical savings account.
8. Keep moving The best way to manage your health and the associated costs is to live a healthy lifestyle. This includes exercising.
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