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Stretching your medical aid benefits

28 June 2022 Bonitas Medical Fund
Lee Callakoppen, Principal Officer of Bonitas Medical Fund

Lee Callakoppen, Principal Officer of Bonitas Medical Fund

Everyone is feeling the pinch and looking for ways to stretch their budget. This is true of healthcare too, especially when it comes to medical cover.

It’s important to manage your medical expenses if you want your benefits to last. The smart move is to know what your plan offers and what you can do to avoid unnecessary out-of-pocket expenses. That way you can save money while managing your health.

Lee Callakoppen, Principal Officer of Bonitas Medical Fund, give us some tips on how you stretch your medical aid benefits.

Understand your plan and what it offers
Knowledge is power and when it comes to medical aid this is especially true. Firstly, it’s important to make sure you have chosen the right plan for your healthcare needs. If you’re battling to make a decision, consult an independent broker. Brokers are accredited by the Council of Medical Schemes so are qualified to offer advice and support and there’s no extra charge for this service. Then, read through the plan you’ve selected and understand all the benefits, limits as well as any additional rules, regulations or added value benefits.

Use DSPs or networks
Using network doctors, specialists, hospitals or Designated Service Providers (DSPs) is essential if you want to make your medical aid last longer. It means you won’t be charged more than the negotiated preferential rates. Remember this includes knowing your scheme’s key providers, such as which ambulance to call in an emergency. Not using a DSP can result in a co-payment or non-payment for the service.

Ask your pharmacist
Consult your pharmacist for advice on over-the-counter medicine and/or switching to generic medicines. Using generic medicine, which has the same active ingredient, strength and dosage as the original brand but is less expensive, helps save costs. In addition, consider using a clinic or nurse practitioner to get your blood pressure screened, for your flu vaccination and other primary healthcare concerns – this saves on the consultation fee charged by your GP.

Managed Care benefits
Most schemes offer programmes to help you manage chronic conditions such as cancer, diabetes, HIV/AIDS and back and neck problems. These programmes are usually covered from the risk portion of your medical contribution and are not funded from your savings account. They help you use your benefits to maximum advantage while ensuring you receive quality care by using specific providers.

Other benefits - such as maternity consultations, wellness benefits, preventative care and dentistry – are also paid from risk by some schemes. Again giving you more value for money and are in addition to your savings and day-to-day benefits.

Boosting your benefits
Carefully read through what your plan offers - especially when it comes to enhanced benefits - and choose wisely. Remember, not all additional benefits are equal. For example does your plan cover childhood vaccines from risk? If so, this is a saving of thousands of Rands, especially in the first 18 months of life

This year, Bonitas invested R446 million in additional benefits through a benefit booster which is available on all plans, including the hospital plan (but excluding BonCap). Members tap in by completing a wellness assessment (which can be done online) and then have access to additional benefits which range from R940 and R2 730 (depending on the plan) to cover expenses such as:

• GP and specialist consultations
• Acute and over-the-counter medicine
• Biokineticist and physiotherapist consultations and treatment
• Paramedical services
• Alternative healthcare
• X-rays
• Blood tests

Go virtual
Look out for telemedicine or virtual consultation options which are around 60% cheaper than an average consult. A doctor will engage with you in a virtual video consultation on a medical issue and advise you on the most clinically appropriate steps for further care.

Be inquisitive, ask questions
Ahead of any procedure, in or out of hospital, ask the right questions. Check that your healthcare provider is on your scheme’s network in order to secure a better rate.

Unless the procedure is an emergency, you will need to get pre-authorisation. At the same time, request a quote so you know, upfront, what the costs will be and whether you will be covered or if you are being expected to make a co-payment. If so, negotiate.

Stay healthy
With Non-Communicable Diseases (NCDs) or lifestyle disease fast becoming a pandemic in South Africa, it’s important to take care of your health by eating correctly, getting enough sleep, exercising and reducing your stress levels.

‘Health is the new wealth,’ says Callakoppen. ‘Your health is important, as are your finances, don’t take either for granted. When it comes to healthcare cover, invest time in researching and understanding the medical aid plan you’ve selected. Read the information sent to you, including the fine print to understand the Scheme Rules. If in doubt, phone the call centre, your broker or financial advisor. This will go a long way in helping you know your rights and making the most of your benefits.’

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