Nowadays most medical schemes have a new-generation option that will typically be a hospital plan with a small savings portion. This means the consumer has the peace of mind that he can go to a private hospital for procedures and has a small savings account for day-to-day expenses. (Tip: Check at which rate your scheme covers hospitalisation.)
What is a medical savings account?
The medical savings plan is designed to cover day-to-day expenses. The consumer gets a total annual amount that is available in advance in his savings account for medical expenses. If a consumer joins the medical scheme during the year, this amount will be calculated pro rata. In terms of legislation this amount may not exceed 25% of his annual premium. Once the benefit has been exhausted, the consumer will be responsible for any further day-to-day expenses. Any positive balance in the savings account at the end of the year will be carried over to the next year.
If the member exhausts his savings component before the end of the year and switches to a new scheme or resigns from the scheme, the scheme may expect the member to repay the difference in savings to the scheme. The amount repayable by the member is the monthly savings multiplied by the number of months left in the year.
Hospital plans with a savings component work on the same principle as the hospital plan, the only difference being that day-to-day expenses such as visits to doctors or dentists are paid from the savings component. This savings component forms part of the premium – you are actually saving your own money to cover day-to-day expenses.
Hospital and savings plans are not the most cost-effective for everyone. Experts believe young and healthy members are often better off with a hospital plan as they do not fall ill very often. Their day-to-day expenses are also not high enough to justify switching to a comprehensive option. These plans are also popular among young and healthy families, but if, for example, a new baby is born, medical expenses could increase to such an extent that a comprehensive plan or network plan would ultimately be cheaper.
Myth: All “in-the-chair” or day procedures are paid from the risk component and not my savings component.
Members must make sure of this. Generally a co-payment applies to such procedures (gastroscopy, colonoscopy, etc.) or payment may be made from the savings component, as the patient is not hospitalised.
Myth: The extraction of wisdom teeth is fully covered if done in hospital.
In the case of most plans a co-payment applies to the extraction of wisdom teeth in hospital. The member is responsible for this. The cost of the specialist and anaesthetist is also paid from the savings component. Once this component has been exhausted, the member will be responsible for this cost.
General tips on how to save on medical expenses
Look around. Do your homework and look around for the best medical cover at the most affordable price. Find out whether any dental and day procedures are paid from the risk component or whether you are responsible for such procedures.
Keep a record of day-to-day expenses. Contact your independent broker or the scheme direct or log on to your account to determine how much you have already spent and how much is still available. Before undergoing any procedure, contact the scheme and find out how it will be paid.
Stay fit and healthy. Prevention is better than cure. The healthier you are, the lower your medical expenses will be. Get the recommended inoculations, as this will prevent unnecessary conditions.
Consider generic medication. Generic medication is the same as the original brand, but can be much cheaper.
Repeat prescriptions can be faxed. If it is a repeat prescription for a non-life-threatening chronic condition, contact your doctor and request him to fax it to the pharmacist.
Consult the doctor that charges medical scheme rates or use designated service providers. It could save you money.
Ask your pharmacist. Pharmacists too can provide sound medical advice on problems such as rashes, colds or illnesses that are not severe. Buy over-the-counter medication or treat less serious ailments yourself.
Avoid consultations after hours. In an emergency one obviously has no choice, but these consultations are very expensive.
Sake 24: Saturday, 5 November 2011