With more than 80 medical schemes in South Africa and more than 200 benefit options, choosing the right medical cover for you and your dependents can be quite baffling
As we review our major expenses for the coming year, the cost of medical cover should be a top priority. After the year we have had, with Covid 19 and the ensuing economic fallout, many people may be reviewing their options and hoping to get better healthcare coverage for less. And it may not be just the plan you are thinking of changing – we all get to the point where we look at our medical aids and hospital plans and the associated costs and wonder if the grass is greener on the other side.
South Africa’s medical aids rank among the best in the world, but with so many companies and benefit options to choose from, comparing medical aids is a time consuming and often arduous task.
Your health is, by far, your most precious asset so before you rush into making any changes to such an essential service, there are a number of important factors and implications that need to be thoroughly evaluated.
Choose an independent Adviser
Given that there are so many options to choose from and that healthcare cover is such a critical (and costly) purchase, it may well be best to seek advice from a professional independent financial adviser specialising in healthcare. These professionals are able to understand your unique healthcare requirements and provide you with unbiased advice because they are not paid to promote only one company’s products.
At Rutherford we offer independent advice on a wide range of medical schemes and benefit options
If you are looking to change plans or your medical scheme, it is essential that you do so at the end of the year so that you enjoy the full year’s benefits of the new scheme during the following year (medical schemes tend to pro-rata benefits if you are not a member for the full year).
The deadline for changes to medical plans is 30 November to ensure that all the paperwork and the switch between plans or medical schemes is completed in time for the new plan to be effective from 1 January 2021.
What do you need from your cover?
Bear in mind that any advice given is based on the information you provide, so spare a few moments to reflect on your specific healthcare requirements and those of any family members. With the variety of options available it really is possible to have a plan that fits your personal needs. So, if you are generally healthy and fit, but have eye problems, choose a scheme that makes adequate provision for your eyes. Some schemes offer great maternity benefits and others more extensive cancer cover. A family with young children has very different medical needs from a single person or a retired couple. Make sure your medical cover is a good match for the health conditions you and any dependents experience or are likely to experience to the best of your knowledge.
Remember to ask about any exclusions or limits and beware of Late-Joiner Penalties (LJP)
Changing from one medical aid to another may leave you without cover for certain conditions for a limited period of time (but not more than one year). Be aware of these possible exclusions before signing on the dotted line. Overall hospital limits should also be checked to ensure enough cover for the unfortunate situation of all the family being hospitalised at the same time.
With the pandemic and downturn of the economy, financial hardships have affected all of us in some way or another. Many have had to cancel their medical aids and replace them with cheaper alternatives, like medical insurance products or settle for no cover at all. Please note, medical insurance is NOT a medical scheme/aid and would thus not be considered credible coverage when calculating LJP.
BE CAREFUL. Having a medical aid membership break of more than 90 days could expose you to Late-Joiner Penalties (LJP) when you rejoin a medical scheme. This is a loading of your medical scheme premium that you would have to carry for the future duration of your membership.
Is the medical scheme financially secure?
And a final note - you wouldn’t want to find out your scheme has gone insolvent when you’re having once in a life- time surgery. So before selecting a particular medical scheme, you’ll want to be assured that it is financially sound and sustainable. According to legislation, schemes should have at least 25% of members’ annual contributions in reserve.
Before making a final decision, make sure you understand your medical scheme and its benefit options. Read the membership brochures and look into the scheme rules.