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Looking To Change Your Medical Cover? Here’s What To Consider

Looking To Change Your Medical Cover? Here’s What To Consider

  • 4 min read

The world has seen so much uncertainty over the past few months, with more uncertainty ahead. These seismic changes around us are causing many of us to re-evaluate our lives, including our budgets.

Whether it’s due to salary cuts or being retrenched, or whether it’s because you now realise how important the health of your family is, your medical aid may be one area you’re looking to make some changes in.

It’s worth bearing in mind that depending on the rules of your scheme, you may not be able to change the specific plan you are on halfway through the year. However, other schemes like Fedhealth do allow you to change your plan (within their scheme) within 30 days of a life-changing event like getting married, falling pregnant or being diagnosed with a dread disease.

Before you go and do that though, here are some questions to ask, so you can make the best decision to suit your changing circumstances:

  1. Out-of-hospital costs

Do you need a hospital plan or a comprehensive plan that includes a medical savings account too? Assess your out-of-hospital costs in the previous year including doctor visits, medicines, optometry and dentistry, among others. Would you benefit from having a medical savings account to fund these expenses, or do you think you can manage on a hospital plan and fund these yourself when they occur?

  • Should I choose a medical aid with a network scheme?

Belonging to an option with a network scheme is one way of bringing your medical aid costs down, but before you commit to that, you need to ensure that there are sufficient hospitals and providers near you. Otherwise you could end up having to use a specialist or hospital not in the network, and then having to make large co-payments.

  • Check up on those co-payments

For certain procedures and treatments, medical aids don’t refund you the full amount – so it’s worth researching what these are before you commit to a new medical aid plan. Gap cover is one way of meeting this shortfall, as it pays in the difference between the full amount owed and what your medical scheme will pay.

  • What exclusions are there?

Most medical aids won’t pay for that cosmetic procedure that they don’t consider essential. Or for a self-inflicted injury. Or for your child’s orthodontist. So before you go and sign up for a new medical aid option, bear these exclusions in mind, in case they are things you may need cover for in the future.

  • Chronic medication

Do you take chronic medication regularly? If so, you should check the chronic medication benefit that applies on the plan you’re considering, and what your annual limits are. Also check that your chronic condition is actually covered by the medical aid, and if there are any co-payments, plus what these are.

  • Waiting periods

Most medical aids have waiting periods when you join, meaning that they won’t pay out for the first three months that you are a member (for any general claim). This is to stop people abusing the system by ensuring that they aren’t able to make large claims shortly after joining, followed by them immediately cancelling their membership. Medical aids also have condition-specific waiting periods of up to 12 months, so if you have a pre-existing condition  (including something like pregnancy) and know you will need treatment within that time period, you need to consider this in your decision. The health of you and your family are paramount so finding the right medical aid option for your needs is a big decision. Hopefully these points will help you evaluate your options and find a plan that suits your lives and budget.