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Top tips if you’re considering a medical scheme or benefit change

25 October 2019 Aon South Africa
Jacqui Nel, Business Unit Head of Healthcare at Aon South Africa

Jacqui Nel, Business Unit Head of Healthcare at Aon South Africa

With most medical schemes having recently announced their increases for 2020 at an average of 10% as well as any changes to their benefit options, you may be considering a review of your healthcare cover and whether it still meets your needs and budget.

Before making any changes, it is crucial to thoroughly investigate and compare your medical scheme options and benefits to ensure that you are not financially compromised by any option change.  It’s a task best undertaken with the guidance of an experienced healthcare broker who can unpack the complexity of the various options, weigh that up against your unique circumstances, claims history, any existing conditions and your budget and then provide impartial advice on the way forward.

According to Jacqui Nel, Business Unit Head of Healthcare at Aon South Africa, “Before making any changes, it’s crucial to thoroughly review the benefit richness of a medical scheme option and the cost of your cover measured against your unique healthcare needs and circumstances.   Medical benefit options tend to be complex because firstly there are many and they all vary widely in terms offering, making like-for-like comparisons tricky at best.  Factors such as a personal needs analysis, review of your claims history and affordability all come into play. While claims history is an indicator, no one is aware of health risks that may occur in the future, so it is important to understand your approach to and ability to take on any risk.  Based on this information, your healthcare broker can advise on the best plan to ensure that your healthcare needs are comprehensively covered and that any change won’t leave you compromised or facing hefty out of pocket expenses that you cannot afford,” says Jacqui.   

When considering changing your option or medical scheme for the new year the following should be taken into consideration:

  • Your current day-to-day expenditure and whether your existing benefits provided sufficient cover or if you were out of pocket.
  • If you or any dependants are registered for a chronic condition, whether it qualifies under the 27 regulated chronic conditions or as an additional disease listing for cover. Consider the savings versus the cost of the additional chronic medicine.
  • If moving to a Network option, are the network providers within an acceptable distance from you?
  • If you are planning a family, undergoing a procedure or currently consulting with a specialist, ensure that this is covered as part of the Network or practice at the hospital network.
  • When you pay less, you normally receive less cover.
  • Benefit options that pay for PMBs only can have an impact on your pocket as you will need to self-fund any non-PMBs, as well as your access to and expectation of care.
  • Should you consider self-funding your day-to-day care, ensure that you apply the discipline to make provision for when you may need medical cover.
  • Get Gap Cover.  Today, most medical schemes have deductibles and co-payments and many members are left out pocket when hospitalised due to provider charges in relation to what gets reimbursed by the medical scheme.   
  • Be comfortable with your savings versus the risk you may be exposed to.
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