Getting the most out of your day-to-day benefits

With the economy in slow recovery, consumers are still stretched to the limit and expenditure on a medical scheme is still a big expense for many families. Peter Jordaan, marketing executive of Fedhealth, the fourth largest medical scheme in the country, has put together some useful tips on how best to manage day-to-day medical costs.

Stretching your day-to-day rands:

• Maybe the doctor is not necessary this time round. Before heading off to your doctor or rushing off to the emergency room, consider if you can get appropriate advice elsewhere which may save you time and money. Some schemes like Fedhealth have a Personal Health Adviser benefit. This benefit is offered to all members through Europ Assistance and is available 24 hours a day on 0860 333432. Questions about unfamiliar symptoms, medical and drug information, common home remedies for dealing with sick children, nutrition and diet or more sensitive questions relating to health are answered in the

strictest confidence by experienced nursing staff. You will be advised to see your doctor where necessary. This is definitely an alternate avenue worth exploring.

• Ask about fees. Before your consultation starts, ask your healthcare professional about his or her fee structure. In some cases, healthcare professionals will charge less if you pay them yourself after the consultation and then claim back from the scheme for a refund at a later stage. This means that the healthcare professional gets their money quicker and also avoids the administration around the process of claiming from your medical aid. Although you have to submit the claim yourself, you generally get your money back within two weeks.

• Generics are just as good. Ask your doctor or pharmacist about generic equivalents for over-the-counter and prescription medication. These medications are of the same quality and efficacy as the original patented medicine and are considerably less expensive.

• A frame is a frame is a frame…Although many schemes will pay for designer frames for your glasses, it will leave you with less day-to-day benefits for the rest of the year. Therefore carefully consider the implications when selecting a frame. Shop around for special deals regularly advertised at the larger optometry outlets. Some of these outlets may even do an eye test for free if you buy your glasses from them.

• Know your benefits. It is definitely worth getting to know your benefits. Find out if any unique benefits like specialised radiology or CT scans can be paid from Risk rather than Savings even when performed out of hospital. Remember you will have to obtain pre-authorisation for this expense otherwise it will be deducted from your Savings. Another important example is trauma treatment in a number of schemes. This bill will also be paid from Risk and not your Savings but only when performed in the casualty ward of a hospital and not your doctor’s rooms. You also need to obtain authorisation within 48 hours after the treatment. In a case of a hospital event, further treatment is very often required after discharge from hospital. Normally this would be deducted from your day-to-day benefit, but again, some schemes do pay for follow up treatments like physiotherapy, radiology and pathology from Risk for up to 30 days after discharge from hospital. Once again you must obtain pre-authorisation before you have this treatment otherwise it will be deducted from your day-to-day benefit. Take-home medication for seven days is also often paid from Risk if this is dispensed by the hospital pharmacy.

“Remember that your savings account is your money and how you spend it is up to you. So please make sure you spend it wisely,” concludes Jordaan.