People frequently complain about the high costs and terms and conditions of their medical aid without knowing what they have signed up for.
According to Madelein O’Connell, executive manager at Bestmed Medical Scheme, it is critical that medical aid clients review and take note of changes implemented from October to December each year.
Bestmed is a self-administered medical plan.
“Medical schemes often update their terms, coverage and costs annually. Your chosen plan should take into account the average premium increase and being with a scheme that has a proven track record for value for money and a focus on customer service,” said O’Connell.
She told Sunday World that the current economic climate is forcing people to tighten their belts.
Key considerations
“There are key considerations when choosing a medical aid suited for your family’s healthcare needs and budget. You need to identify what you need based on your age and lifestyle.”
O’Connell stated that when choosing the right medical aid cover, a person has to consider their own health, and weigh a range of factors.
“These include your potential future medical needs and the health providers that the scheme allows you to use. Also the budget you have to spend on such cover that best suits your requirements.”
She revealed that many schemes offer preventative care and wellness benefits at little or no cost. These can include vaccinations, screenings and health assessments.
“Understanding that one has access to these benefits at no extra cost, may give one an advantage in taking preventative care.”
There’s a confusion between medical insurance and medical aid. O’Connell said: “Medical insurance covers your day-to-day medical expenses and provides limited hospital cover. Unlike medical aid, medical insurance usually settles the claim with the member. [The member] is then responsible for paying their respective healthcare providers.
Medical aid vs Medical insurance
“Medical aids generally interface directly with the healthcare provider. Medical schemes are also required to cover a prescribed list of minimum benefits for their members. These include a range of life-threatening emergencies and 27 chronic medical conditions. Thus offering far more comprehensive cover.”
She shared that they have made room for their members who have mental health issues. This because they understand that mental health should be managed actively.
“We understand that there is direct correlation between mental and physical health. And we introduced our tempo wellness programme. This to help our members cope with the challenges that life throws at them. [And] give them benefits and tips on how to manage them. All our members have access to the Tempo benefits, regardless of their selected benefit option.”
