A number of recent high profile liquidations of medical aid schemes in South Africa have highlighted the importance for consumers of making a very careful choice when selecting which medical scheme to join.
While members of insolvent schemes are sometimes given the option to transfer to new schemes, this is not always the case. In such cases, it is vital to engage the services of a specialist healthcare broker, as some consumers may either be subject to a three month waiting period or, in some cases, condition-specific exclusions from the new medical aid scheme.
If the customer already suffers from a Non Prescribed Minimum Benefit chronic condition, it is crucial to establish which schemes and options will pay for the specific chronic medicine used by the member. As a result, members should not join a new scheme without confirming whether they will provide the specific medicine.
It is important to obtain the advice of a qualified and accredited healthcare broker when navigating the various medical schemes on offer. Choosing the right scheme can prove to be quite a minefield, so it is vital consumers take the time to speak to a broker as they can explain any potential risks as well as analyzing the client’s lifestyle to ascertain what scheme would be most suitable.
It is also important to look at the current profile of the medical scheme when choosing which one to join, such as the number of members, the average age of members and the pensioner ratio. All of these factors can impact on the long-term sustainability of a scheme; for example, if the age profile and pensioner ratios are significantly higher than other schemes, then one could be at risk of higher than average premium increases.
Once a consumer has identified the right scheme with the help of their broker, it is also important to determine which option on the scheme best suits their needs. Consumers should take care not to make wrong option selections as changing these options might only be allowed once per annum, especially if you want to upgrade to a more comprehensive option.
The broker can also assist with annually reviewing the scheme and option as the needs of the member changes. This is a highly dynamic and extremely complicated industry, which makes it almost impossible for the consumer to make a decision on a suitable scheme and option without obtaining advice.
Medical scheme terminology, codes, rules, legislation and constantly changing benefits and medicine formularies can be very confusing to members, so if one has any concerns they should raise them with their health care broker who can either explain what it means or investigate any changes on the member’s behalf.
A person’s health is the most important asset they have and not taking the time to choose the right scheme now can lead to significant misunderstandings over the benefits available and have a devastating impact financially when it does become time to claim.
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