For more and more South Africans, investing in medical aid schemes is becoming critical to insuring access to the levels of health care that your family will need, both now and in the future. Medical costs are surging ever upward, and the need for high quality medical care has never been greater.
• What are medical aids? These are schemes similar to insurance policies where a medical aids provider will agree to cover the cost of specific medical procedures and treatments in exchange for a monthly fee or premium. The range of items covered and varies from scheme to scheme, as does the amount of coverage available for each item.
• How do they work? Medical aid schemes, again like insurance policies, work on the principle of shared risk. The provider seeks to determine how likely that the families enrolled in their schemes will require some of many services that they cover. Based on that, they determine how much they will have to charge to cover those costs, plus a profit.
From the consumer’s point of view, enrolled families are paying less in monthly rates that they would if a serious injury or illness should befall one of their family members.
To help make the distribution of fees more equitable, providers will often give discounts to families whose general health and habits make them less likely to be the ones who need the big ticket treatments.
• How much do they cover? Many plans cover nearly 100% of all costs for any medical issue, from the trivial to the most severe. This usually includes checkups and follow ups as well as surgery, hospital visits, and treatment for chronic illness. As you might expect, these plans are the most expensive, since the risk to the provider is the greatest. Generally, people who are using this kind of plan are either very wealthy, or are working in a job or industry where subsidized medical aid plans are offered.
Other schemes offer limits to the coverage to reduce the monthly rate to the point that the average family can afford it. The most common of these is the hospitalization scheme, where the week to week medical expenses are taken care of by the family. These would include the checkups, routing prescriptions, minor injuries, and other low priority issues. The scheme will, on the other hand, cover the serious issues that can devastate the finances of most families. Things like: o Emergency room care. o Surgery. o Long term treatment of chronic or illnesses. o Treatment of serious conditions, including heart disease and cancer. o Long term rehabilitation services. • How do you get enrolled in one of these schemes? The basic thing to do is get a quote from several of the medical aid providers and compare the costs, features and limitations. This can be done in several ways: o Call or correspond with the companies directly. They will have in house customer service agents that can help you get started on getting a quote. o Contact a representative agent who handles the schemes of each providers that you to investigate. o Look online for quotes from each provider that you are interested in. o Contact an independent agent who works with multiple firms and can help you determine the best scheme and provider for your needs.