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The year has posed many uncertainties and now, without knowing what the future holds, private medical aid members need to decide on their medical scheme options for the forthcoming year.


One lesson Covid-19 has taught us is to ensure we have sufficient healthcare funding policies in place that suit our own, as well as our dependants, financial capabilities and medical needs.


Most medical schemes offer benefit plans with various levels of cover, and from 1 January you can select any of the plans on offer by the medical scheme, without being penalised.


Typical categories of cover to evaluate within the available plans are:

  • limited or unlimited cover
  • medical scheme tariff against the actual cost
  • provider choice
  • upfront payments from your own pocket in the form of co-payments


Restrictions can make your medical choice more affordable, as freedom of choice always comes at a price. The best way to make your medical scheme benefits stretch is by determining your and your dependants’ medical needs and understanding how various benefits and components of your medical scheme work and what they cover.


Tips to stretch your benefits:

  • Use network doctors, optometrists, dentists, hospitals and pharmacies instead of opting for freedom of choice in provider
  • Visit your general practitioner first instead of going directly to a specialist
  • Use the listed medicine to avoid co-payments
  • Use more affordable generic medicine rather than the patented version, as it can drastically reduce your spend on medication
  • Consider using telephonic consultation services if available

Using the scheme’s selected providers and medicine will assist in full payment from the scheme, or at least in preserving your medical scheme savings account that is used for out-of-hospital or day-to-day expenses.


If you can afford a medical insurance gap policy, this will supplement your medical scheme option. Medical insurance gap policies can cover most of your shortfalls or co-payments when opting for a medical scheme option with tariff or cost restrictions, or limited provider choice. Gap cover can also enhance certain set cover limits.

In a time of consolidation, it is important to also look at your health cover and consolidate your funding options to ensure appropriate cover at a more affordable price.

Speaking to a healthcare adviser will ensure you get the very best out of your cover, as they can advise on your individual needs when choosing a plan, which can ultimately save you in the long run. No two individuals are alike and therefore what they require out of a medical scheme plan will differ, so consult a professional about cover that suits your personal budget.


Source: By Annelé Oosthuizen, branch head at Alexander Forbes Health
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