How to make the most of your medical aid scheme

It is important for consumers to know how to make the most of their medical aid schemes to ensure they get the healthcare they are entitled to and avoid out-of-pocket expenses.

This is especially important in an environment where consumers feel perpetually cash-strapped and healthcare costs are ever-increasing.

Fedhealth principal officer, Jeremy Yatt, gives some guidance on how to maximise your medical aid benefits:

Medical aid network options: Use listed providers and save

Many medical schemes offer network options at a reduced monthly rate to allow for members to be sure of the price they will pay. These networks may include providers like GPs, hospitals and specialists.

“If you are on a network option, you should try to use the listed providers to avoid paying unnecessary co-payments,” Yatt advised.

“Fedhealth members on a GRID [network] option, for example, save 11% on their monthly contributions and still have access to 120 world-class hospitals for planned procedures.”

ALSO READ: Can’t afford medical scheme membership? Here are some alternative options

Benefit from preventative and health screenings your medical aid covers

Prevention is better than cure, the saying goes and it is true.

“Early detection of a health issue may save you hundreds of thousands of rands over the long term and possibly, your life,” said Yatt.

“Most medical schemes have a screening benefit which covers things like the HPV vaccine, mammograms and health risk assessments. Understand what your policy covers and commit to routine check-ups.”

Use any value-added services or programmes your scheme offers

Many schemes offer programmes or services that provide additional value, such as programmes to stop smoking, weight management or even toll-free medical helplines.

Find out what your scheme has in place and make sure you get the full benefit of these free services.

Do not pay more for prescription medication

Apart from only using your plan’s approved pharmacy provider to fill prescriptions and avoid co-payments, Yatt says consumers must remember that generic medications have the same ingredients but cost less than the originator product, so ask for these when possible.

ALSO READ: Looking for a medical aid scheme? Here’s how to choose the best one for your needs

If you want to change your medical aid plan

Yatt says that the end of the year is traditionally medical aid renewal season, when many people relook their cover. Consumers usually decide to change their plans when:

• There is a change in your financial situation, such as losing your job or a significant chunk of your income and you must consider downgrading.

“Remember, a lower medical aid plan means fewer benefits and therefore always try to match your healthcare requirements with the plan you select. On the other hand, if your financial situation improved over the past year and is set to continue along this path, you could consider upgrading your cover for additional peace of mind.

• You plan to have a baby as maternity care does not come cheap.

“It is best to embark on the pregnancy journey with a solid medical aid plan that has good maternity benefits.

“Fedhealth members can upgrade at any time of the year within 30 days of a life-changing event diagnosed, including pregnancy. Remember, if you are not an existing member of a medical aid plan, there is usually a 12-month period post joining before you can access pregnancy benefits, for example.”

• A change in your health.

“Should you be diagnosed with a chronic condition or life-changing illness, such as cancer, it may be wise to consider changing your medical aid plan to one that has better benefits to help you manage your specific condition.”

• Your dependants get older. Parents often keep children who are students or young working adult children as dependants on their medical aid.

“In some cases, it could be more cost-effective to move these young adults to their own memberships for as little as R945 per month if they are under 35 and healthy, which is cheaper than an adult dependant contribution on many other medical aid options.” 

Smart ways to cut costs and maximise benefits

Yatt says in tough financial times, it is wise to look for smart ways to cut costs and maximise benefits by understanding exactly what your medical option includes.

“Consider chatting to a trusted financial adviser who can holistically look at your finances and advise on the best plans for your circumstances and ways to take full advantage of everything your option covers.”