This is the time of the year to evaluate your medical aid option and decide whether the benefits have adequately covered you and your dependents through the year. If there has been changes to your health that will require additional treatment and or medication, this is an ideal time to look at your options to see if upgrading your option will be more cost effective and enhance the cover your receive for your condition.
Often an area of concern is running out of savings during the year. This can either be due to having a bad year health-wise and needing more consultations than usual or being on the wrong plan. Our normal expectations are that a savings plan should cover all out of hospital expenses.
A savings plan is really a hospital plan with some funds for out of hospital expenditure. We often place a higher value on this part of our plan than on where the real value is, that being the value the hospital plan offers for emergencies or planned procedures. In reality we should still set aside additional funds for out of hospital needs as the savings is there to supplement out of hospital expenditure and when we have years where we need more out of hospital treatment than usual these funds often get depleted.
If you run out of savings every year in the first half of the year then you might be on the wrong plan or you need to set up your own saving to cater for the shortfall you have each year.
Gap cover is also a very important part of your medical cover. If you are on a plan that pays medical aid rates then it is crucial to also have gap cover as this will ensure you are covered even for specialists that charge 4 to 5 time the medical aid rates. If you are on a comprehensive gap plan it will also cover co-payments imposed by your medical plan as well as enhance your Oncology cover and give you additional cover when you have reached your plans sub-limit for internal prosthesis. Most gap options also give you a casualty benefit for emergency ward visits at hospital due to an accident; one of the great little benefits we often don’t know about.
Most gap queries we have are from people who are faced with a huge specialist bill because the medical aid only paid a potion towards the specialist account and the client needs to pay the balance. Often this is in the tens of thousands and if you are not already a member you cannot go onto gap and then be covered immediately for a claim, so it is imperative to look at taking out a gap policy and see the monthly premium as an investment to cover a future expense.
Look back on the year on determine whether your plan worked for you or not. If it did, it might be worthwhile sticking with a working plan. If on the other hand it didn’t work for you then it is really in your best interest to make an appointment with us so that we can help you choose a plan that will best suit your personal situation.