How to make the most of your medical aid

Jeremy Yatt

With South Africans feeling perpetually cash-strapped and healthcare costs seemingly always on the rise, it’s critical to make the most of your medical aid by optimising all available benefits.

Whether you’re on a hospital plan or have comprehensive cover, make sure you receive the care you’re entitled to, while avoiding out-of-pocket expenses as much as possible.

Here, Jeremy Yatt, Principal Officer of Fedhealth, a preffered healthcare provider of Sanlam Health Solutions, offers guidance on how to maximise your medical aid benefits:

1. Make sure you use network providers if you’re on a network option
To allow price certainty for members, many medical schemes offer network options at a reduced monthly rate. These networks may include providers like GPs, hospitals and specialists. If you’re on a network option, you should try to use the listed providers to avoid paying unnecessary co-payments. For example, Fedhealth members on a GRID (network) option save 11% on their monthly contributions and still have access to 120 world-class hospitals for planned procedures.

2. Benefit from the preventative and health screenings covered by your medical aid
'Prevention is better than the cure’. Early detection of a health issue may save you hundreds of thousands of rands over the long term - and, possibly, your life. Most medical schemes have a screening benefit which covers things like the HPV vaccine, mammograms and health risk assessments. Understand what your policy covers and commit to routine check-ups.

3. Utilise any value-added services or programmes offered by your scheme
Many schemes offer programmes or services that provide additional value to their members, for example programmes for smoking cessation, weight management or even toll-free medical helplines. Find out what your scheme has in place and make sure you get the full benefit of these free services.

4. Don’t pay more for prescription medication
Apart from only using your plan’s approved pharmacy provider to fill prescriptions and avoid co-payments, remember that generic medications have the same ingredients but cost less than the originator product, so ask for these when possible.

Yatt says that the end of the year is traditionally medical aid renewal season, when many people relook their cover. Here are some of the circumstances that may prompt a change in plan:

• If there’s a change in your financial situation, for example, you’ve lost your job or a significant chunk of your income, you may need to consider downgrading. Remember, a lower medical aid plan means fewer benefits, so always try to match your healthcare requirements with the plan you select.

Conversely, if your financial situation has improved over the past year and is set to continue along this path, you could consider upgrading your cover for additional peace of mind.

• If you’re planning a baby: Maternity care does not come cheap, so it's best to embark on the pregnancy journey with a solid medical aid plan that has good maternity benefits. Fedhealth members can upgrade at any time of the year within 30 days of a life-changing event being diagnosed, including pregnancy. Remember, if you are not an existing member of a medical aid plan, there’s usually a 12-month period post joining before you can access pregnancy benefits, for example.

• A change in your health: Should you be diagnosed with a chronic condition or life-changing illness, for example cancer, it may be wise to consider changing your medical aid plan to one that has better benefits to help you manage your specific condition.

• Your dependants’ age: Parents often keep student or young, w orking adult children as dependants on their (the parents’) medical aid membership. In some cases, like for example on Fedhealth’s flexiFED Savvy option, it could be more cost-effective to move these young adults to their own memberships for as little as R945 p/m granted they are under 35 years old and healthy, which is cheaper than an adult dependant contribution on many other medical aid options.

Yatt concludes that in tough financial times, it’s wise to look for smart ways to cut costs and maximise benefits, by understanding exactly what your medical option includes. Consider chatting to a trusted financial adviser who can holistically look at your finances and advise on the best plans for your circumstances, and ways to take full advantage of everything your option covers.