HEALTH FEATURE MEDICAL AID SCHEMES IN 2021
31 October 2020
Cancelling your medical aid should be a last resort It’s the time of the year when medical aids launch their plans and costs for 2021 – the time to make important decisions to ensure that you and your family have access to quality healthcare. The ‘open season’ for medical aids gives you the opportunity to reassess your medical needs and affordability for the year ahead. It’s an important but sometimes difficult decision. Tough economic times The last six months have made it even more difficult. When your income is threatened, reduced, or in the worst-case scenario has dried up as a result of the pandemic, deciding where to spend and where to save becomes critical. In circumstances such as retrenchment, or periods of reduced employment, it may be tempting to consider quick-fix solutions and take a break from your medical aid. “But,” says Lee Callakoppen, Principal Officer of Bonitas Medical Fund, “we strongly advise against this. “South Africans are facing many challenges during this tough time and we are aware of the financial implications the lockdown has placed on everyone,” says Callakoppen. “The pandemic has put a spotlight on the need for quality healthcare and having medical aid will ensure you get exactly that.” Healthcare costs are high - always about 5% more than inflation and now, more than ever, South Africans will find these costs prohibitive. For example, two weeks in intensive care could cost around R392 340 and in a general ward it’s around R99 201. The alternative is public healthcare.
network options. In addition, it is strongly advised that you consider benefit richness against your contributions. Some tips from Bonitas when deciding on health cover: Read the small print It’s important to read all the information about the plans, so that you understand exactly what is covered and what isn’t. Have a look at your healthcare costs over the past 12 months, including: • What you spent on day-to-day healthcare expenses • Was anyone admitted to hospital? • Did you need to visit a specialist? • How often did you visit a GP? • Do you have any chronic conditions? • How much was spent on dentistry, optometry and overthe-counter medicine? • Did you use up your day-to-day benefits and/or savings in the year? • How much did you pay in copayments and/or deductibles? • Also consider once-off costs
Getting advice Callakoppen says, “Deciding on a medical aid plan needs to be an empowered decision. It is imperative that the decision you make regarding you and your family’s health is balanced against the benefits you require and affordability. Medical aid plans can be confusing, which is why it’s important to compare the various options and benefits to ensure you find an option that works for you and your dependants. For people who have a broker, this should be the first point of call to help you make an informed choice.” Buying down is a consideration, or looking at network options that offer marked savings. The Bonitas Select Plans, for example, are priced 15% cheaper than non-
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that won’t come up again soon (childbirth) and those likely to come up again (such as flu). Age impacts your decision • If you have young children, select an option with enough child illness benefits • Check the maximum age of child dependents • If you’re older, select a plan that provides sufficient inhospital cover in the event of hospitalisation, and that covers chronic conditions. Day-to-day detail Medical aids are not-for-profit and belong to their members. For this reason, they have to ensure they contain costs for the benefit of all their members. So it’s important to look at the day-to-day benefits carefully. Additional benefits Ask what extra benefits might be available that could save significantly on day-to-day expenses. These could include: Preventative care benefits, ranging from basic screenings (blood pressure, cholesterol and BMI measurements) through
to mammograms, pap smears and prostate screening. In some cases this extends to maternity programmes, dental check-ups, flu vaccinations and more. Look at virtual care options on your medical aid and what value you get from them. Ensure affordability of the plan When comparing different medical aid options, consider all the costs involved before you make your final decision, such as: • Monthly contributions - as a rule of thumb, should be around 10% of your monthly income at an individual or household level • Generally, the lower the cost of the option, the fewer the benefits available to the member regarding medical treatment, healthcare providers and medications. Comprehensive medical aid or hospital plan? • A medical aid plan covers members’ healthcare costs, in and out of hospital, such as treatment and medicine – as well as simple day-to-day benefits and hospital cover. The plans have set limits for specific benefits and costs are covered according to the rules of the medical scheme and the member’s option. • A medical aid hospital plan provides you with basic, yet important medical cover. Hospital plans differ from scheme
