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SUB CATEGORIES General  |  HIV |  Medical Schemes | 

The value of a healthcare adviser

17 June 2021 Rachel Janssens, Principal Consultant at Alexander Forbes Health
Rachel Janssens, Principal Consultant at Alexander Forbes Health

Rachel Janssens, Principal Consultant at Alexander Forbes Health

Navigating the vast number of schemes available and sifting through all their options to find the best fit for you and your family is almost an impossible and time-consuming task.

When looking for medical aid cover we often find ourselves overwhelmed by complexity in the range of schemes and plan options, medical jargon, fine print on medicine lists, designated service providers and possible exclusions.

Understanding the benefit design, rates and clauses is important, but there are many other factors to consider, such as: Is the scheme financially stable, how will they underwrite you, and will you be exposed to penalties and waiting periods?

You do not have to have a healthcare adviser to belong to a medical scheme. However, using one can help you cut through the complexity of medical scheme matters and the variety of benefit options.

Medical aid advisers are specialists in providing advice and services about joining a medical aid scheme. They should have your best interests at heart at all times. Having an adviser with extensive knowledge of the industry and complexity of the products is crucial.

Your relationship with your adviser will continue past that important first step of joining to receiving ongoing services and support throughout your lifetime:

• Liaising with the medical scheme on your behalf about difficult claims that have been rejected
• Updating you on new rates, benefit changes and increases for the following year to select a suitable medical scheme or option
• Reassessing your changing health needs and advising whether you should upgrade, downgrade or remain on the option you are on
• Explaining consequences of changing schemes and your rights to ensure you are protected
• Discussing the impact of any changes in legislation
• Giving feedback on the financial stability of your chosen scheme
• Providing ongoing educational support
Healthcare advisers are independent in their advice and conduct in-depth risk analyses and ongoing health assessments. In this way, you can weigh up the most appropriate medical aid options based on your budget and specific health requirements.

Before advisers can provide advice and intermediary services, they must be accredited by the Council for Medical Schemes comply with the code of conduct under the FAIS Act, enforced by the Financial Sector Conduct Authority.

There is no additional cost to you by having a broker, as brokers are paid by your scheme and not by you. Their fees are governed by regulations under the Medical Schemes Act. The fees are currently either 3% of your contributions or R101.91 a month, plus VAT, depending on which amount is lower.

Quick Polls

QUESTION

Healthcare brokers have long complained about inflation-plus medical scheme contribution increases; but pandemic may have changed things. What will pandemic-induced changes in hospital utilisation do to medical scheme contribution increase patterns?

ANSWER

Below inflation increase for 2022, then back to inflation-plus
Long-term trend of below inflation increases
Inflation-linked hikes for 2022, then back to inflation-plus
This is a 2-year hiccup, inflation-plus increase trend remains in place
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