6 crucial medical aid factors to know

NOWADAYS, medical aid has become a very important need, however, there are essential factors that every member should know about it.

Executive head of Healthcare Consulting at NMG Benefits, Gary Feldman, says it is critical to understand the benefits medical aid members are entitled to so they can get the most out of it.

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Essential factors members of medical aid should know:

Review of benefits

Find out when your medical aid updates its benefits and revises its premiums and review them to ensure that you’re not caught off-guard when it comes to claiming.

Above-threshold benefits

An above-threshold benefit is like a safety net. Once you deplete your medical savings account, you enter the self-payment gap, where you are liable for the costs of medical care out of your own pocket. Once you have reached the end of the self-payment gap, your above-threshold benefit kicks in.

“You must submit every healthcare invoice to your medical scheme so they can keep track of when you reach the above-threshold benefit,” says Feldman.

Late-joiner penalties and waiting periods

Medical schemes can apply late-joiner penalties if the member joins after age 35 or if they have not belonged to a medical aid for a specified period of time. There are also waiting periods for existing conditions.

Medical savings account

Feldman says that in a scheme with a medical savings account, any remaining funds must be carried over into the new year. “This means you can build your medical savings account up if you are in good health and do not claim often. For a traditional medical aid, nothing is carried over. So, choose carefully between a traditional medical aid or a new generation product that includes a savings account.”

Medical aid and health insurance

With medical aid getting increasingly more expensive, many people are opting for health insurance instead. These two products are not the same. The benefits you get from a medical scheme are more comprehensive as they must cover a specified list of prescribed minimum benefits.

Feldman says medical aid contributions qualify for a tax credit while health insurance premiums don’t.

Gap cover

Medical aid rates can be lower than the rates that specialists charge. Gap cover is a short-term insurance product that covers the costs of certain unforeseen hospital procedures.

“It is a real value-add and is cost-effective – especially considering the peace of mind it will give you,” concludes Feldman.

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