Nowadays most medical schemes have a new-generation option that will typically be a hospital plan with a savings portion. This means the consumer has the peace of mind that he can go to a private hospital for procedures and has a small savings account for day-to-day expenses. What is a medical savings account? The medical savings plan is designed to cover day-to-day expenses while having fewer restrictions on the choice of providers. The consumer gets a total annual amount that is available in advance in his Medical Aid Savings to account for medical expenses. If a consumer joins the medical scheme during the year, this amount will be calculated pro rata. In terms of legislation, this amount may not exceed 25% of his annual premium. Once the savings are exhausted, the consumer will be responsible for any further day-to-day expenses. Any positive balance in the savings account at the end of the year will be carried over to the next year. If the member exhausts his savings component before the end of the year and switches to a new scheme or resigns from the scheme, the scheme may expect the member to repay the difference in savings to the scheme. The amount repayable by the member is the monthly savings multiplied by the number of months left in the year. Here are seven tips to make your medical savings last longer: 1. KNOW YOUR PLAN Understand what you’re covered for, at what rates and with which providers. Does your plan cover you at the medical scheme rate or at a higher rate? Does your plan require you to make use of a hospital or pharmacy network? Refer to the material you receive from your medical scheme, use their website and talk to your financial adviser about what your options are. 2. KNOW YOUR DOCTOR’S RATES Patients are often embarrassed to discuss money with their healthcare provider, but when you make the appointment, ask what rates your doctor charges and whether you’ll be liable for any co-payments. That way, you can make informed decisions about how you’re spending your healthcare funds. If affordability is your greatest concern, it might be better to shop around for a provider who charges scheme rates, but if choice is more important to you and you’re happy to pay more, you’ll know upfront exactly how much. 3. TAP INTO NETWORKS YOUR SCHEME MAY HAVE Some medical schemes have network arrangements in place with healthcare professionals. By using a network, the scheme pays the professional directly, reducing administrative hassle and keeping costs down for you. The Discovery Health Medical Scheme, for example, has an extensive GP network where members are covered in full for doctors’ consultations. We recommend that our members call us or visit our website before they see a healthcare professional, so they know which of these are part of a network. 4. IF YOUR SCHEME OFFERS DIRECT PAYMENTS WITH CERTAIN SPECIALISTS, YOU CAN BENEFIT TOO For example, Discovery Health Medical Scheme has direct payment arrangements in place with most of South Africa’s specialists on most of its plans. If you see one of them, you won’t be liable for any co-payments. If you choose to see another specialist, you may need to pay upfront or pay a portion of the costs yourself – depending on your plan. Find out what your options are. Don’t be afraid to discuss and agreed rates with your specialist. 5. CHECK FOR FULL-COVER ALTERNATIVES In the case of medicine for a chronic illness, schemes often have formularies – lists of medicine that are covered in full by the scheme. Check with your doctor or pharmacist if your prescribed medicine is covered in full and ask about options if not. 6. PAY IN CASH FOR OVER-THE-COUNTER MEDICINES If you have a medical savings account, don’t claim for items not normally covered by medical schemes, for example, over-the-counter headache tablets, cough preparations, etc, from your savings. Paying cash will help the money in your savings account last longer, so you have funds available for more serious, more expensive out-of-hospital treatments. 7. STAY HEALTHY! It seems obvious, but people often overlook the fact that by taking care of their health, they can reduce their healthcare costs in the long term. Make use of your scheme’s preventive screening benefits for regular health checks and live a healthy life. In the case of Discovery Health Medical Scheme, members have access to a range of preventive screenings funded by the scheme. Members can join Vitality, which rewards them for being healthy. Please contact our Health Department, email health@daberistic.com , to find out about different Medical aid options
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AuthorKevin Yeh Archives
January 2025
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