• What are medical aid schemes?These are programs created by medical aids providers to help cover the expenses of medical treatment. • What kinds of items can be considered covered expenses? Literally any medical item from a flu shot to a triple bypass can be covered by a medical aid scheme. However, while the more costly schemes cover a wider range of expenses, many of the more affordable schemes do not.
• How does the provider make money? Basically, it’s a process of balancing risk. The provider knows how much of each kind of medical service will be required by the families within a specific segment of the population. For instance, they can tell very accurately how many people within the group will require surgery for heart disease in the next 5 years. Based on this, they set their rates cover those projected costs and leave some extra for the company bottom line.
• What is covered? All schemes, by government mandate, must pay the expenses of a specific set of illnesses, procedures and treatments. This includes item like emergency room care, surgery and the treatment of several common chronic diseases. Beyond this list, it is up to each medical aid provider to determine which expenses are covered by each of their medical aid schemes.
To find out what each scheme covers, you will need to ask for a quote which details the features and limitations of each scheme, along with the estimated monthly rate.
• What kinds of schemes are out there? The medial schemes break down into basically three groups:
o Closed schemes. These are schemes generally subsidized by employers on behalf of their workers. They tend to both be very comprehensive and costly, but the cost to the worker is reduced due to the subsidy and volume discounting. Most government workers and police receive enrolment in a close scheme as part of their employment agreement. Some private companies have contracted directly with medical aids providers to offer a similar benefit to their workers. o Full feature open schemes. These are schemes which are open to the public, but are so costly that only the wealthiest can participate. o Limited coverage open schemes. These schemes at least provide coverage for the mandated services. Some cover more expenses, but charge a higher price in the process. Families looking for a discount on open medical aid schemes will need to check out quotes from these firms to determine which, if any, can meet both their budgets and their coverage needs.
• How is the rate determined? The rate for any medical aid scheme depends on three main factors: o How many people in your family are covered. o How many medical issues are covered. o How likely is it that your family members will be severely injured or succumb to a serious illness in lifetime.
• How can you reduce the cost of these open plans? There are a few things that you can do to find an affordable open medical aid scheme: o Shop around. Looking at all of the plans out there will help you find the best deals. o Look for plans that are tailored to your family’s needs. Like any business, medical aids providers are trying to capture their share of the market. One way that they do this is to specialize in families with specific needs. Finding a scheme that offers a break on the kind of medial problems common to your family can help you save money. o Improve your medical profile. Quit smoking, lose weight, get fit. By making your self and your family healthier, you can begin to take advantage of discounts in medical aids plans. o Limit your coverage. By going with high deductibles and co-pays, and going with only the coverage that you need, you can also save money.