Katharine Child | 09 October, 2014 09:56
From now until December 1 you can switch your medical aid or change the option you are on. The Times spoke to the experts for some advice:
1. Shop around for medical aid:
"You may spend same amount on medical aid as rent but people don't investigate or understand what they are buying, as they do when they rent a house," said Healthcare expert Len Deacon, who has worked in the industry for 25 years.
2. Look at what you think the future holds for next year.
"Are you a new couple planning a baby or an older person needing an operation that you have been putting off? Has your child been diagnosed with a chronic condition? Did you take up an extreme sport and could need more physiotherapy than before?"
See what the different plans within medical aids offer and if it meets your new health status.
Some medical aid options offer more physiotherapy limits, others have excellent maternity benefits. Cheaper plans pay less for hospital costs than do more expensive options.
Certain medical aids offer dentistry benefits from the benefits without touching your savings.
3 . The more freedom you want to choose your specialist, the more you pay.
"Do you want to choose your own doctor or do you want to have save money?" asks Deacon. In order to save money, medical aids use doctors they have contracted to, which they call Designated Service Providers or network doctors.
If you choose a medical aid with network hospitals that you need to use, check that there is a hospital near you that you are able to use.
4. Remember when a scheme says it pays 100 % of hospital rates, this does not mean 100% of what is charged, but 100% of what the medical aid's own tariff is. If the hospital or specialist has a higher tariff than the medical aid tariff, you will have a co-payment.
If you don't want to pay co-payments choose a more expensive medical aid that offers 200% or 300% of hospital and specialists rates.
Alternatively, buy gap cover to pay the difference what a specialist charges and what the scheme will pay. This is usually around R100 a month.
5. If your medical aid increase is low, compare benefits with last year to ask are they cutting benefits to cut costs.
Wits Professor and Health Economist Alex van den Heever said consumers are unlikely to be hurt too badly because The Council for Medical Schemes has to approve all changes and check medical aids have not slashed benefits and raised prices.
* What different medical aids are offering.
-Genesis Medical Aid offers the cheapest increases of 5.5% and its Private Plus options offer dental appointments up to R25 000 that don't come out of your savings accounts but are paid from medical aid benefits. It also offers MRIs both in and out of hospital.
-Fedhealth Principal Officer Peter Jordaan claims that the benefit structure remains unchanged compared with last year with no cuts. There are unlimited benefit GP benefits on Maxima Saver and Maxima EntrySaver members for the coming year. What this means is that members can use GPs, part of Fedhealth network, once there savings are depleted.
-Bonitas claims that it pays the highest number of claims submitted compared with any open medical scheme 98%. It's most expensive option pays hospital and specialist tariffs at 300% of accepted rates. Depression has been added as a chronic condition on the BonComprehensive option which gives almost R12000 towards medicine on Bonitas formulary of accepted medicine. Bonitas Medical aids offers one free HIV test and one free flu vaccine a year
-Compcare Medical Aid offers school readiness tests for children between age five to seven and psychometric testing for high school teenagers.
- Discovery Medical aids offer mammogram screenings out of the screening benefits for cancer.All members can have virtual consultations with doctors out of savings benefits. Members can sign up for Health ID, so that all their medical records are electronic and available to a doctor who uses the app. This helps if you go to many different specialists. The medical scheme said that Vitality members who use the gym and health eating benefits are healthier and have less and shorter hospitalisations.