Choose medical cover that best suits your needs

Your alarm clock wakes you and it’s time to get ready for yet another day at work. You get dressed, eat breakfast and brush your teeth. Just before exiting the house you realise you forgot something and rush back to get it. In your haste you step on one of your kids’ toys. You fall awkwardly on your shoulder and feel a sharp pain.

It is at this point that medical bills, doctor visits and hospital fees circulate in your head as you pray that your injuries are not too serious.

We have all had an accident or two, been stuck with the flu or hospitalised for some reason. Should you get a medical aid, hospital plan, or neither and aim to play it safe?

This all depends on your lifestyle and quality of living, but because an accident can happen in an instant, experts suggest that an affordable hospital plan is the least you should have to cover yourself financially.

According to Selfmed, a hospital plan is the ideal option for people who want complete health cover for major medical expenses at a reasonably fixed monthly rate.

According to Johanna Cicione, medical broker at JC Medical Aid Brokers, the most important aspects to look at when considering a hospital plan are the exclusions on certain procedures, rates and surcharges.

For chronic illnesses and full peace of mind for various health issues, the best option would be to go the traditional path and take a comprehensive medical-aid plan that covers in- and out-of-hospital costs. Some cases also include membership bonuses such as discounts on shopping, movies or gym contracts.

Cicione also mentions that every medical aid must adhere to PMB’s (prescribed minimum benefits) which should cover a minimum of 26 illnesses, such as asthma and epilepsy.

According to Selfmed, the difference between comprehensive medical-aid cover and hospital plans is the costs and benefits involved.

“A comprehensive medical aid is one that offers both hospital cover and day-to-day benefits, such as doctor appointments and medication. A hospital plan on the other hand, covers in-hospital treatment only and does not provide day-to-day benefits.”

It would be a costly experience to have a hospital plan and yet visit the doctor every month, while it would be the same case for a young and healthy individual to have a comprehensive medical plan, when doctor visits are minimal.

This is why various medical schemes will have different plans to suit your needs. This will depend on the medical aid an individual considers.

One of the main disadvantages of comprehensive medical-aid cover is that it is very expensive, especially if you are not making use of all of its benefits on a regular basis.

Hospital plans are affordable and provides hospital cover, with some medical aids providing unlimited cover for the duration of one’s hospital stay. According to Selfmed’s website, some hospital plans do have restrictive regulations that may only cover a certain amount of surgical operations.

Luckily there are a number of average costing health-insurance plans that cover the gap between the more expensive comprehensive medical aids and hospital plans.

With the cost of living increasing each year, it is vital to choose medical-aid cover that is both affordable, gives peace of mind and caters to your needs.

People have increasingly opted for hospital plans and are managing expenses by using medical savings accounts or medical credit/debit cards, according to Selfmed’s website. Another option for the cash-strapped individual would be to take out medical insurance, which is a policy offered by insurance companies covering a set amount per day for hospitalisation needs. Some of these companies also give its clients cash-back incentives, but do not cover every eventuality.

According to Thulani Mathebula of Clientele Life, hospital and medical insurance are some of the necessary additions to your medical plan.

“We provide R5 000 hospital cover if the person is in hospital for more than 48 hours. We then deposit the money straight into his bank account so that it can be used to buy medicine or for savings. Remember that you cannot get covered when only going for a check-up at the hospital. Our job is to give sound financial aid for skyrocketing medical bills. Hospital stays can cost in excess of

R 80 000,” he mentioned.

Hospital insurance also eases the costs and helps individuals who are not getting paid at work due to mandatory hospital stays. “These families suffer financial losses and we are there to help them bridge the gap.”

Complications could arise in hospital, especially after a serious accident and then you would want a hospital plan to cover excessive hospital bills.

Chronic illnesses can also derail your bank account when you least expect it and according to medical-aid companies it is important to consider your family’s medical history when choosing a medical scheme. It is better to join one beforehand as costs can escalate especially if you are a student or young upcoming professional.

According to the Council for Medical Schemes South Africa (CMS), medical inflation has risen rapidly as a result of the exodus of younger and healthier members from full medical coverage to low-cost hospital plans.

The council also states that the rise of inflation occurs because medical schemes may no longer turn down new applicants. The cost of medical equipment and the list of prescribed minimum benefits can also be added to this list.

According to CMS it is important to employ the services of a broker when in doubt, so that the selection of a scheme can be based on informed consent.