Mild heart attack, with double bypass ... R300 000
Treatment for stroke after getting the bill ... R200 000
The opportunity to insure your estate against medical cost ... Priceless!!
In a perfect world, we would all be covered by the National Health Insurance, for a fraction of the cost of what we are currently paying for our medical aid cover, and none of us would have to worry about the financial side of treatment. Why not go even further and demand that government takes care of us all after retirement and for that matter why not have Angelina Jolie work as my PA?
The answer to all of the above is neither government nor I have the funds to make our dreams come true!
When it comes to medical care and the dream of a National Health Insurance there are some hard truths:
Only about 16% of the population is currently on medical aid.
The rest either do without or make use of public facilities.
The current infrastructure for public health care is at only a fraction of what is should be to deal with the demand. The result, ineffective care, purely as a result of numbers.
Private health care initiatives, through various activities and involvements, supply roughly 50% of all public health care.
The proposed National Health Insurance will need around R210 BILLION to get off the ground to be able to deliver what they promise. Not much I agree, but compared to the current Rbn 7 it is quite a leap forward! Where will this come from? Raise income tax by 8-10%? I think the small percentage of actual tax payers would notice!
Although we can all comment about the economics of such a proposed scheme, the truth is, there are babies and children dying on a daily basis, because they cannot get the health care they need, so we can all agree, there is a problem, but we need a workable solution.
Yes, a private medical aid is costly, but far less than the alternative of not having a medical aid.
By getting onto your own medical aid, if you can afford to, you are saving lives!!
When considering a medical aid and or evaluating your current medical aid, it is important to get involved. As medical aid advisers we can clarify and point out certain benefits or pitfalls, but we will never know your circumstances as good as you do.
One of the biggest problems with medical aids is that the members do not know what they are covered for and to what degree. It is equally as important to know what you are NOT covered for!
The answer is simple. Read your STATEMENT OF BENEFITS at least once a year and then ask questions!
Why not phone your local hospital accounts or your GP and ask their opinion on a medical aid you are considering!
The medical aid requirements will differ for each person, depending on medical history, age, life stage, occupation, hobbies, travel and so forth. For this reason most medical aids offer a few variations of their scheme for members to consider.
With medical aid, we tend to steer away from the smaller schemes as we believe in two things:
Size does matter and
You get what you pay for.
Although there is a lot of factors to take into consideration, like operating cost, demographics of client base, reserves and so forth, size will determine the medical aids bargaining power and ultimately the value for the members.
I might sound arrogant to say "you get what you pay for" but it is a simple fact in life. You cannot expect to save on you medical aid premiums and then be angry at your adviser or medical aid if something happens and there is co-payments or treatment that is not covered. Once again, get involved and know what you are paying for!
The following three categories of cover should be considered:
Major Medical Expenses
Your greatest financial threat lies with hospitalisation.
Unexpected trauma or elective surgery can cost a fortune.
You don't know when it may happen or how much it will cost
Will you accept an overall limit on hospital cover? Again, it costs less, but remember that if your family are hospitalised together, you could be in serious financial trouble!
Is there limitations on the amount of days spend in ICU?
Is oncology covered at private or public hospitals?
Day-to-day costs
Most "New Generation" medical aids have a savings account, from which out of hospital expenses are paid. The scheme will "credit" you your total monthly savings up front in your account. Whatever is left at the end of the year, rolls over to the next year.
Some schemes offer threshold benefits, where if your savings are used up and your claims have accumulated to a defined amount - the scheme will pay further claims for that year.
Other schemes pay limited claims from a pool of all member funds.
You can still buy a "traditional medical aid" - where everything is covered - from a few companies, but in truth there are always sub-limits that has to be considered.
If a benefits sub-limit is reached the member will be responsible for further payments for the rest of the year even if the overall limit is not reached yet.
Chronic medicines
By law, schemes have to pay medication for 25 conditions (Prescribed Minimum Benefits).
However, they can still control the type of medicine and only pay medicines that fall within their lists (formulary).
Medicines for other conditions may be covered by the scheme or paid from your savings.
If you have a chronic condition, make sure it falls under the schemes conditions covered and that the medication that you have to take for that condition is covered. If not you may want to consider another scheme. For instance being prescribed certain designer drugs if you suffer from MS, will it be paid or not?
And then there are the more personal factors to consider
Auxiliary benefits
How important is emergency evacuation by air?
Do you travel to other African countries? in case of emergency must you be evacuated to the nearest point of treatment or back to RSA?
Is it important to be covered when travelling abroad?
Is it important that new and or certain experimental designer drugs or treatments, for instance for cancer treatment be covered?
Is it important to be covered for overseas treatment if not available locally?
