Category Healthcare
SUB CATEGORIES General  |  HIV |  Medical Schemes | 

Maximise medical aid savings, make benefits last longer

08 February 2016 Jill Larkan, GTC
Jill Larkan, Head of Healthcare Consulting at GTC.

Jill Larkan, Head of Healthcare Consulting at GTC.

It’s tempting to want to splurge on over-the-counter vitamins and supplements or some other lifestyle item when medical aid benefits, limits and savings accounts get renewed come 1 January each year, especially after the costly festive season spending.

GTC’s Head of Healthcare Consulting, Jill Larkan, cautions however that members should spend medical aid savings prudently and use benefits wisely, particularly in the early part of the New Year.

“The governing body of this sector - the Council for Medical Schemes (CMS) - recently released commentary urging members to make medical aid benefits last longer,” says Larkan. “We completely concur with the CMS. Spending sensibly from the outset helps to extend the availability of funds later in the year, while ensuring you are able to retain a positive balance in your savings account for as long as possible.”

The acting Chief Executive and Registrar at the CMS, Mr Daniel Lehutjo, said in his statement that “members should resist the urge to spend all their benefits in the first couple of months” and “not to use your benefits to buy sunglasses, multivitamins or other lifestyle items over the counter.”

All South African medical aids run financial years concurrent with the calendar year. This means that all the benefits (with the exception of oncology), limits and savings accounts are “renewed” on 1 January each year. When the New Year comes around a bulk lump sum of money is allocated to every member’s medical aid savings accounts and this sum is the accumulation of the next twelve, savings allocation portions, of the monthly premiums.

“The lump sum of advanced annual savings needs to last until the end of December, and any non-essential items purchased now may unnecessarily increase any self-payment gaps which may require attention later in the year, once your savings are exhausted,” continues Larkan.

Some additional tips from Larkan and the CMS which would help to extend members’ medical aid savings include:

• Check if your medical aid has a formulary list of medications and if they do have one, request that your doctor, as far as possible, only dispenses listed medicines. A formulary is a list of prescribed medications – both generic and branded, for which your medical aid scheme will pay. The formulary helps to guide you to the most cost-effective medications that are effective for treating a particular condition.
• If your scheme offers preventative screening tests, paid for by the scheme, get a list of these, and have as many done as possible, ensuring that any potential health issues are detected and addressed as early as possible.
• If you take chronic medication, check that you are registered as a chronic medication member with your scheme, ensuring that as much of your monthly costs as possible are covered, by your scheme. If there is a Chronic Management program for your ailment, register for this and follow the program to improve, monitor and maintain your health.
• Ensure that you know whether there is a designated service provider stipulated by your medical aid which you are required to use for various medical procedures. These service providers may include pharmacies, hospitals, doctors, specialists and even optometrist networks. Ensuring the designated service providers are used will help to curb additional expenses which service providers not in the network/s may be charging.
• Obtain procedure codes and confirm authorisation and cover levels provided by your scheme. Understand what your portion of payment will be. Discuss these rates/tariffs with your doctor and negotiate these wherever possible.

“By incorporating as many of these strategies as possible, members will be well on their way to maximising valuable medical aid savings. Professional advice from experienced medical aid consultants and advisors should be sought – whether through one’s employer or in a personal capacity – to ensure the retention of as much of your savings as possible,” Larkan concludes.

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