Choosing the right Medical Aid

Lee Callakoppen

Being healthy, living a healthy lifestyle and having access to medical care - when you need it – should not be taken for granted.

However, the reality is that to make sure you live your best and healthiest life, you need access to medical aid cover. The challenge is finding the right plan to suit your healthcare needs and that you can afford.

‘With so many medical aid plans on offer, making an informed decision can be daunting,’ says Lee Callakoppen, Principal Officer of Bonitas Medical Fund. His advice is not to rush the decision but to take time to do some research and to ask some pertinent questions about the cover you actually need. This should include an analysis of your current health status and also factor in potential life stage changes.

Your needs
Most important is to look at what health and medical care you might need given your age, your state of health and that of your family. Compile a simple cost analysis of your medical bills over the past year or two to see what you have spent and where you spent this. Was it on dentistry, chronic medication, optometry, or GP visits?

Then be realistic about your future plans: Are you young and healthy, with minimal medical needs or are you planning to start a family, are you close to retirement, do you have any existing medical conditions? Taking these all into account will help you make a better choice.

What plans are on offer?
Medical schemes offer a range of healthcare options – from traditional through to hospital, savings, network or income-based plans – that makes private healthcare more affordable. Some will cover GP visits and day-to-day benefits; others require you to use network practitioners and hospitals while others only cover medical costs when you are in hospital.

‘Most medical aids provide an online option to compare two or three plans which is a great way to assess the difference in benefits, co-payments and monthly contributions,’ says Callakoppen. ‘At Bonitas we offer a wide range of plans, 15 grouped in five categories: Savings, traditional, hospital, Edge (virtual) and income based.
‘We have tried to keep things simple with our plans structured to meet a diverse range of quality healthcare options,’ says Callakoppen. ‘In fact, member feedback and recent industry awards, confirm that our plans are easy to understand and that accessing benefits is simple.

‘Part of our range of plans, that are easier on the purse-strings, include Efficiency Discounted Options (EDOs) that use network healthcare providers and are around 15% less for the same benefits. Our Edge plans are aimed at new entrants to the workplace, economically active singles or couples and driven by technology and ease of access through virtual integration and digital intervention.’

What can I afford?
Affordability of the monthly contributions is an important consideration. As a rule of thumb, this should be around 10% of your monthly income at an individual or household level.

He points out that, generally, the lower the cost of the plan, the fewer the choices available to you regarding medical treatment, healthcare providers and medications. It’s also important to remember that in South Africa, if an individual takes out private medical aid after the age of 35 for the first time, a late joiner penalty may be imposed on their membership for the rest of their life.

Read the small print
Take the time to read the information sent to you by the scheme and/or your broker. Benefits vary from plan to plan, so establish what is and isn’t covered.

Ask what supplementary benefits might be available that can potentially save significant day-to-day expenses. These could include preventative care benefits, ranging from basic screenings (blood pressure, cholesterol, blood sugar and Body Mass Index (BMI) measurements) through to mammograms, pap smears and prostate testing. In some cases, this extends to maternity programs, dental check-ups, flu vaccinations and more.

What about savings?
Medical savings are a fixed amount a medical scheme gives you at the beginning of the year. There are ways to maximise your savings but first you need to know what your annual allocation is.

Waiting period or exclusions
Some schemes may impose certain waiting periods for new members joining or for a pre-existing medical condition. This is based on the guidelines of the Medical Schemes Act 131 and the specific scheme’s rules. Enquire with the relevant scheme about their exclusion list and waiting periods.

Still confused?
To help you navigate the complex medical aid landscape, Callakoppen suggests you use a broker. ‘Brokers are accredited by the Council of Medical Schemes and qualified to offer advice and support and there’s no extra charge for this service. They will help you work your way through the different options to choose the medical aid plan that is best suited to you and your family’s needs.’