pregnancy & birth
L&L | AUGUST 2019 | 21Choosing a medical scheme
When comparing the different medical
aid options available, consider
all the costs involved before you
make your final decision, such as:
● Can you afford your monthly
instalments given your monthly
income and expenses? The general
rule of thumb is your medical aid
contributions should be around
10% of your monthly income at an
individual or household level.
● Usually, the lower the cost of the
option, the fewer the choices
available to the member
regarding medical treatment,
healthcare providers and
medications. However, this can
greatly benefit you if you have
limited resources available for
healthcare, or if you don’t have
chronic and existing conditions
and are relatively healthy.
● The cost of co-payments. A medical
aid co-payment is a fee the member
is liable for when making use of
certain medical services. When the
medical aid doesn’t cover 100% of
the cost, the member is required
to pay a certain percentage of
the medical service before the
medical aid pays their portion.
The co-payments usually apply
to specialist or elective medical
procedures. However, this
differs from one medical aid
scheme to another and is one
reason why you should always
do thorough research before
deciding which medical aid
scheme is the best option for you.
Bonitas also offers the
following advice:
● Disclose all information about
your and your dependants’
health. Membership can
be suspended or cancelled
if you fail to do so.
● How good is the payment record?
Phone your GP’s receptionistto find out whether they have
experienced problems with
pay-outs from particular schemes.
● Check the scheme’s solvency
ratio. According to the law,
schemes should have at least
25% of a members’ annual
contributions in reserve.
● Scrutinise the table of benefits.
Things might look good on
paper, but check what the
day-to-day limits are and how
much your Medical Savings
Account is per year. If it’s small,
you could exhaust your day-to-
day cover quickly. Also remember,
many private hospitals don’t
charge medical scheme rates,
so check what co-payments
you will have to make.
● Find out if there’s a waiting period
or exclusions. Schemes may
impose certain waiting periods
for new members joining or for a
pre-existing medical condition.
This is based on the guidelines
of the Medical Schemes Act and
the specific scheme’s rules. »If you’re already
on medical aid
“Before you decide on the
best medical aid option, you
need an idea of what your
typical healthcare costs are,”
says Lee Callakopen, principal
officer of Bonitas Medical
Fund. Reflect on the following
over the past 12 months:
● How much you
spent on day-to-day
healthcare expenses.
● If you or any of your
dependants were
admitted to hospital.
● How often you visited
a specialist.
● Do any of you have any
chronic conditions?
● The amount you spend on
dentistry, optometry and
over-the-counter medicine.
● Whether you exhausted
your day-to-day benefits
and/or savings in the year.
● How much you paid
in co-payments and/
or deductibles.
Now consider which of the
expenses listed above were
once-off and won’t come up
again soon (like childbirth)
and which are likely to come
up regularly (like flu).