Health is wealth, which is why ensuring you and your loved ones have access to the best healthcare when they need it most is critical.
Let’s take a look at why it’s essential to compare different medical aids and benefit options, what you should be reviewing, and how to make an informed decision.
First, it’s important to know that not all medical aid options are created equal. Some only offer in-hospital cover, while others provide limited or more comprehensive day-to-day benefits. Dental benefits, vary greatly from option to option, as do self-payment gaps and how and when medication is covered. Some medical aids also have specific networks of doctors or hospitals you must use. Knowing which network hospitals different medical schemes are contracted with and being comfortable with them is crucial to ensure accessibility and convenience.
Based on your needs, contributions can also vary significantly between providers and options. Without thorough comparison, you could end up paying more for less cover, or for additional reward programmes that you don’t need. Finally, as you progress through different life stages, your health needs change. An option suitable for a young, single individual might no longer suit a family expecting children or someone who is nearing retirement.
By comparing medical schemes and benefit options, you ensure you’re not caught unaware when you need the cover most.
How to compare medical aid schemes and benefit options
Here’s a quick checklist of all the things you should be looking at when you review and compare medical aids. If you have questions or are unsure what the best fit will be for you, reach out to a consultant and they will be able to assist you as well.
- Benefit options: Medical aids range from hospital to comprehensive options. Decide if you’re looking solely for in-hospital cover or if you also need day-to-day benefits like doctor visits, dentistry, or optometry.
- Benefit limits: Look for any limits on specific benefits. For instance, some options may have a cap on what they’ll pay for certain surgeries or procedures. The good news is that in South Africa, Prescribed Minimum Benefits (PMBs) have been mandated. These are a set of defined benefits to ensure that all medical scheme members have access to certain minimum health cover, regardless of the benefit option they have selected.
- Chronic disease cover: Chronic diseases can be a significant expense. Determine if the option covers these conditions and which medications are included.
- Co-payments: Some medical aids might require you to pay a portion of the costs for certain treatments or procedures. Be aware of these to avoid unexpected expenses.
- Contribution costs: This is a significant deciding factor. While it’s tempting to opt for a more affordable option, ensure it provides the necessary cover. Conversely, the most expensive option might offer benefits you don’t need.
- Network restrictions: Check if your chosen option has specific network restrictions and if these align with your preferred healthcare providers.
- Waiting periods: Some options might have waiting periods for specific conditions or treatments, especially if you have pre-existing conditions and you are taking out medical aid for the first time.
Making the decision
After thoroughly researching and comparing your options, the decision-making process begins. First, prioritise your needs. List your must-haves, like specific treatments, medications, or doctors and ensure the option you choose covers these.
While health is priceless, you also need to ensure you’re making a financially viable decision. Strike a balance between cost and cover and know that you can increase cover as your career develops. Rather have a hospital option than no medical aid at all, for example. There are also usually a range of options to choose from. At Profmed, each of our benefit options have a Savvy equivalent that has a lower contribution because only network hospitals can be used.
Next, research the medical aid provider’s reputation. Client reviews can give insight into the efficiency of claims processing, customer service, and overall satisfaction. If in doubt, consult with an independent medical aid broker. They can provide clarity, answer specific questions, and might even be aware of nuances or upcoming changes in options.
Finally, review your chosen option annually. Your medical aid option should not be set in stone. Regular reviews will let you see if your benefits align with your needs.
