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How to survive Medical Aid premium increases

How to survive Medical Aid premium increases for 2021 and end up saving money

The cost of living has skyrocketed this year and most families are having to tighten their belts in order to make ends meet each month. Individuals are therefore under pressure to eliminate expenses that are not delivering real value to their lives. Gone are the days where South Africans are prepared to pay for services or benefits they are not using or do not need.

Medical Aids are famous for lumping benefits together and charging fixed premiums to their members. Each year, exorbitant increases are announced, and consumers are expected to absorb these additional costs into their budgets even though in most cases, premium increase percentages are higher than average salary increases.

In previous years, medical schemes have passed annual increases in the range of inflation plus 3-5%, which would have meant total increases of 6-8%. However, for 2021, increases have been in the 4-6% range (with several schemes passing increases as low as 4%). One medical aid (Discovery Health)  has come in with a 0% increase, which might fool consumers initially into thinking that would be the best option, but it seems the scheme has plans to pass an increase in June 2021.

Consumers must not be fooled by the percentage increases announced by medical schemes but should rather take a deeper look at price versus benefit and what the total impact will be to their pockets over the full year, in other words the true cost, including what is NOT covered in their medical plan.

Even though these 2021 price increases are the lowest increases the industry has seen for some time, the consumer remains concerned and is looking for ways to save on this onerous monthly expense. The conundrum is that given current uncertainties with COVID-19, having a medical aid and access to private healthcare, has become increasingly important but also increasingly burdensome given that medical aid premiums in some cases are costing families of four or more the equivalent of a home loan repayment and is now one of their biggest monthly expenses.

Medical scheme members feel hard done by and disenchanted with their medical schemes because in addition to the incredibly high premiums they pay monthly, they still find themselves forking out money for day-to-day medical expenses, over the counter medication, co-payments and short-payments.

What should consumers do if they can’t afford their medical aid premium increase for 2021?

First – do not cancel your medical aid unless it’s your absolute last resort! In the short-term you might save on monthly premiums, however if you are not covered, an unexpected illness or accident can ruin you financially, or you may be forced to compromise on the care you receive as you can no longer afford the best.

According to a recent study conducted by the American Journal of Public Health, more than half of all bankruptcies (58%) can be tied back to medical expenses and an estimated 530,000 families in America file for bankruptcy each year because of medical bills and health issues. While exact or similar stats are not available in South Africa, one can imagine that those having to fund medical procedures privately themselves could end up in a similar situation. There is no doubt that having the right medical aid in place and additional insurance like Gap Cover can save you and your family from financial disaster.

Second – know and understand your current plan inside and out. It is important that you understand exactly what you are covered for, what benefits you receive and at what rates. It is possible that you are ‘over-insured’ on your current plan. Even though it’s better to be safe than sorry when it comes to your health cover, you could be better off financially and you could be saving money by changing to a different plan instead of paying a high premium for cover you do not need. For example, if you are not planning to have children then why be on a plan with top maternity benefits?

Third – review past medical costs. It is important that you keep track of your medical expenses. That way you can review the extras you are spending money on outside of your medical scheme and try to find a plan that better matches your needs. Also, you might see that you are spending so much on out-of-hospital expenses that a simple hospital plan will no longer suffice, and a more comprehensive plan would actually save you money over time, or vice-versa.

Considering changing plans?

When considering a change to your medical aid plan, or a change of schemes, there are a few things to keep in mind. Such as, it is important that your age and current health-risks are assessed before changing plans.

By law, your new medical scheme is allowed to provide three underwriting conditions:

  1. A three-month general waiting period where no claims are covered besides the prescribed minimum benefits and chronic conditions.
  2. A 12-month, condition-specific waiting period if you have been diagnosed with a pre-existing condition, for example cholesterol. The new scheme might not cover any costs related to that condition for a year. This waiting period can only be applied if you have not been a member of a scheme for 24 months or if you do not join a new scheme within three months.
  3. A late joiner penalty, this only applies if you did not previously belong to a medical scheme and are 35 or older.

All of the above considered, unless you are incredibly healthy and the saving is significant, it might be the best option to stay with your current scheme and rather just change plans to better suit your needs.

Finally, find the best plan for you, based on your current health, your age, your day-to-day needs, your risks, and how many dependents you have.

Review your plan in detail along-side the plan you are considering. Check what it covers and what it does not. The better you understand this, the less likely you are to incur additional expenses during the year. For example, your scheme may specify that you need to get authorisation before consulting a specialist and failing to do so can be a costly mistake as your claim will be declined.

Reviewing your medical scheme and plan can be overwhelming and extremely time consuming without help from technology. It is advisable to use online tools like www.medicalaid.co.za which is South Africa’s best medical scheme comparison website. Here you will be able to find the best medical cover for your healthcare needs and budget. The comparison looks at monthly premium, hospital choice, overall annual limit, cancer cover, reimbursement rate, day-to-day cover, benefits, MRI/CT scans, maternity benefits and chronic cover.

Most schemes allow you to downgrade during the year, but will only allow upgrades in the renewal window (November/December) effective 1 January of the following year.

World Tobacco Day

For most tobacco users, tobacco cravings or urges to smoke can be powerful. But you’re not at the mercy of these cravings.

31 May | World No Tobacco Day

When an urge to use tobacco strikes, remember that although it may be intense, it will probably pass within five to 10 minutes whether or not you smoke a cigarette or chew on some tobacco. Each time you resist a tobacco craving, you are one step closer to stopping tobacco use for good.

Good reasons you should stop

Quitting smoking lowers the risk for cancer, coronary heart disease and improves the functioning of blood vessels, the heart, and lungs. As soon as you stop smoking your body begins to repair itself.

Tobacco contains nicotine and produces chemicals like carbon monoxide that speed up your heart rate and elevate your blood pressure. The same can occur if you vape with nicotine-based e-cigarette fluids. The effect is immediate the moment you inhale.

Within the first 24 hours of quitting cigarettes, your heart rate, blood pressure, circulation will improve and the carbon monoxide levels in your lungs will return to a more normalised state by the end of the first day. And, after one to three months, your lung function could improove by as much as 30%. Over time, your risk of life-threatening health problems, including heart disease and stroke, drops dramatically. 

Here are 10 useful tips to help you quit smoking.

  1. Decide on a date and do it
  2. Throw away reminders of smoking (ashtrays, lighters, old cigarette packs)
  3. Drink lots of water to flush the nicotine from your body
  4. Exercise more – take your dog for a walk
  5. Change your routine – avoid situations that make you smoke for first 2 days
  6. Rally support by telling friends and family that you have quit
  7. Understand that its normal to experience dizziness, headaches and coughing for at least 14 days
  8. Focus on getting through the first 2 days – after that it gets easier as cravings start to reduce
  9. Eat at regular times and snack on healthy foods in-between to avoid weight gain
  10. Don’t give in to the ‘just one cigarette’ excuse when a crisis or stressful situation occurs

Adapted from source: cansa.org.za

Over time, your risk of cancer, lung disease, and many other serious diseases will be much lower than if you keep smoking

How fast and how well your body recovers can depend on the number of cigarettes you normally smoke and how long you’ve been smoking, and whether you already have a smoking-related disease. The sooner you quit the sooner your body can start to repair itself. Remember, trying something to beat the urge is always better than doing nothing.

Take the 24-hour challenge now – and get one step closer to being totally tobacco-free.

Some medical aids offer assistance to help you quit smoking. To find out if your medical aid has benefits like this, or to find one that does, get in touch with one of our specialist consultants.

You can also make use of our FREE and independent medical aid price comparison tool that compares prices and benefits of all the top medical aids in South Africa, engineered to compare your existing medical aid option with industry alternatives.

Covid-19

Covid-19 and your medical aid

Since the Coronavirus entered the country, we have been told to take precautionary measures like washing your hands and not touching your face but one precaution that has been overlooked is checking your medical aid. With lockdown a reality, now is a good time to check what you are covered for or how you could save money during and beyond the Covid-19 crisis.

The question that has been on South African’s minds lately: “Are medical aids covering COVID-19 related claims?”

The answer to this question is not that clear and often depends on the following:

  • The type of cover you have – members on hospital plans do not have access to day-to-day benefits.
  • If you have any saving left – members that find themselves in a self-payment gap may incur out-of-pocket medical expenses.
  • How sick you get from the virus – in some cases members will show mild flu-like symptoms while in other cases emergency and/or in-hospital treatment may be required.

Quite soon after the first confirmed case of Covid-19 in South Africa, the Council for Medical Schemes (CMS) released a statement saying most medical health insurance providers would pay for tests for the novel coronavirus.

As of 18 March 2020, Discovery Health, Momentum Health, Profmed, Fedhealth, and GEMS, have all released statements confirming that their members would be covered for coronavirus testing.

BUT there are some T’s and C’s attached to this commitment:

  1. If your test for Covid-19 comes back negative, then the claim will be paid out of your savings.
  2. If you have no savings account linked to your plan, or you have run out of savings for the year, you will have to pay for the test out of your own pocket. This amount is estimated at just under R1,500 per test, excluding the doctor’s consultation fee.
  3. If your test for Covid-19 comes back positive, you will be covered for the cost of the test, any consultations associated with the diagnosis and supportive treatment and medicines.
  4. In some cases, as with Discovery Health, members will be able to access Discovery Health’s “WHO Global Outbreak Benefit” which is opened up when a declared global outbreak like Covid-19 occurs. At the point of a positive diagnosis, members are covered for out-of-hospital costs for related treatment from the Scheme and not from their day-to-day benefits. Most of South Africa’s larger medical schemes hold reserves specifically for events like Covid-19. The challenge however is, if an outbreak goes on for too long then those reserves could deplete.

In most cases, schemes rules for members whose symptoms to Covid-19 do not result in emergency type treatment, will likely be no different to if they presented with a flu virus.

Covid-19 in itself is not a PMB and mild presentations of this disease do not form part of the conditions covered as a Prescribed Minimum Benefit (PMB). In other words, you need to be really ill and present with various COVID-19 complications like pneumonia and respiratory failure before treatment will be covered as part of PMBs. In addition, you will need to be hospitalised to have access to any hospital benefits.

Paying for Covid-19 tests and medical treatment is not the only consequence facing South African consumers.

The imposed 21-day lockdown from midnight on Thursday, March 26 until midnight on Thursday, April 16, 2020 will have significant implications for business and individuals. While this measure is intended to slow down the spread of infections and save the lives of hundreds of thousands of South Africans, it will result in additional financial strain for households.

With the complete shutdown of non-essential businesses for 21 days, the question is how many, especially small businesses, will survive – and the real question, how many jobs will be lost, particularly those employed in the travel and tourism and related industries. Should these businesses survive, they will be faced with additional ‘resurrection’ costs when they reopen and may not have sufficient cash reserves to pay their employees beyond a month or two of the lockdown. While there is some talk of loan restructuring from financial institutions, it may not be enough for already over-indebted consumers that have had to dig into their own savings and reserves to fund ‘emergency shopping’ and feeding kids that are now in ‘holiday mode’.

As disposable income starts to diminish, consumers may be looking to cut out some of their bigger monthly expenses in order to fund their households. With medical aid premiums being one of the biggest household expenses, the concern is that consumers may feel the temptation to cancel their medical aids. This is by far the worst time to be without private medical cover. Covid-19 is going to be around for some time still.

For right now, those that are under financial pressure, there are options:

  1. Check your medical aid cover – you may be over insured and could pay less monthly by eliminating cover you don’t need.
  2. Do a price check on your medical aid and compare your premium with other medical aids that could be offering the same cover for less.
  3. Switch from a medical aid to medical insurance. It’s a much better alternative than having no cover at all.
  4. If you are able to, consider adding Gap Cover to your plan. This way if you do end up in hospital, you will be covered for any shortfalls incurred from in-hospital specialist treatment. Just remember there is a 3-month waiting period, so rather act now.

You can do all this at www.medicalaid.co.za. The service is free and supported by a team of expert consultants that can assist you with saving money.

The tight economy and it's impact on Medical Aid

The tight economy and its impact on medical aid

Increasing petrol, electricity, water and food prices, and salary increases that barely cover the cost of inflation leaves the average South African consumer under tremendous financial pressure to make ends meet each month. The National Credit Regulator released the Consumer Credit Market Report stating, “more than half a million consumers [are] no longer in good standing on their credit records” (Moepya, 2020). It is time to make serious decisions concerning the financial situation we find ourselves in.

Is the cost of medical aid contributing to the financial pressure on consumers?

There is a worldwide phenomenon, where the high cost of medication and new medical technology is pushing up the cost of medical expenses for the average consumer. “Although the industry increases this year may appear steep during a tough economic climate that continues to put a strain on consumers’ pockets, various factors need to be considered, such as rising medical inflation rates, ageing scheme profiles and regulatory requirements,” says Damian McHugh, executive head of sales and marketing at Momentum Health Solutions (Fin24, 2020). While the increases seem justified the consumer is still caught in the crossfire.

Having medical cover offers consumers peace of mind, but the monthly contributions might be too much for consumers to bear!

It’s no secret that South Africans are struggling to maintain their medical aid repayments and may in many instances be considering ways to reduce this monthly expense. This is a risky decision which warrants doing research into the options available and how to reduce costs while getting the best cover available within budget constraints. Consumers that are considering cutting their medical aid from their monthly budgets to maintain other financial obligations, must carefully evaluate their options. Here are some ways to reduce medical scheme contribution costs without cancelling cover altogether:

  1. Are there any other costs that can be cut?

    While this option may seem obvious, its often perceived by consumers that it’s easier to cancel a medical policy than to try to reduce other living expenses. Running a family budget is never easy as it requires buy-in and commitment from the whole family. Reducing unnecessary costs is preferable to losing your medical cover. As such, consumers should take a hard look at their situation and consider sacrificing some luxury items like private schooling, DSTV subscriptions, eating out and maybe even selling off a second car.

  2. Investigate dropping your medical cover to a cheaper option (like a hospital plan)

    The number of benefits consumers opt for will determine how much they pay. Consumers should therefore investigate more affordable options with reduced benefits that their current scheme offers. The bigger the scheme, the more options available. However, consumers that are part of smaller schemes will have a more limited choice and may need to look outside their current scheme for better deals. One of the key challenges with trying to downgrade to cheaper cover is that most schemes only allow members to change to a different option once a year, usually towards the end of the year. Therefore, consumers will need to plan carefully and allow enough time to do their research, so that they can make an informed decision within this specified period. This is not a decision to be rushed.

    Some of the more common downgrade options that can be considered include dropping down to a cheaper option with limited out-of-hospital cover and/or a smaller medical savings plan or no savings plan at all. There are also options available whereby consumers pay less if they use providers that are listed as part of the scheme’s doctor network or take up medical insurance to replace day-to-day cover offered by a medical aid. Whatever the decision, when deciding to downgrade your cover, be mindful of your own and your family’s current and possible future needs. Find an option that has suitable cover while at the same time fits your budget.
  3. Manage the dependents on your scheme

    If you have three children, there is no rule stating they all must be listed as dependents on your medical scheme. Most consumers don’t know this. While it may be risky, immediate savings could be made by removing healthy child dependents from your scheme, keeping only those with greater medical needs covered. A better risk to take than to have no cover at all. Should the main members financial situation improve, they could always add the other dependents back again. Just remember that there might be waiting periods imposed in this event.

    Another consideration is the cost of children that move from ‘child dependent’ status to ‘adult dependent’ status when they near the ages of 18-21 (depending on the scheme). As children change to adult dependents, their monthly contribution in some cases could double. Consumers in this situation should consider moving healthy adult children onto their own, more affordable hospital plan. Another option is to register your adult dependent as a student. As long as you have proof that your adult child is a full-time student with no income of their own, most schemes will allow for a discounted student rate. Also, some schemes only charge for three child dependents, so families with more than three children should definitely look at moving to one of these schemes.

All of these options are not as ideal as full comprehensive medical cover, and each comes with its own risks. However, the risks associated with these reduced cover options are still far better than the alternative of no cover at all.

All of these options are not as ideal as full comprehensive medical cover, and each comes with its own risks. However, the risks associated with these reduced cover options are still far better than the alternative of no cover at all.

Understanding how your medical benefits work is a daunting task for most consumers. For example, a scheme might cover a member for 100% of hospital costs at the medical fund rate. This doesn’t mean that all in-hospital costs will be covered, and uninformed consumers could still be left with an enormous bill for making use of a specialist that charges more than the medical fund rate.

Consumers wanting to explore how to get the most out of their medical aids in this tough economy should make use of resources like the free instant online medical aid comparison tool available at medicalaid.co.za. Make the right choices for 2020 and beyond.

South Africa National Healthcare Bill

South Africa’s NHI Bill – How it will affect you

Have you heard the news? By the year 2026, South Africa’s National Health Insurance Bill will be in full swing. Finally! Every South African will be entitled to free, world-class health services.

Great news! 

Or is it?

At the moment, South Africa’s healthcare is being financed by medical schemes and hospital cash plans but these only benefits those who are employed and fall within the middle- and upper-class income groups; those belonging to the lower-income groups are left to fend for themselves should they need medical attention.

Around 84% of South Africans currently rely on the country’s public health system, some of whom wait up to 5 years to receive lifesaving treatment.

In theory, South Africa’s National Health Insurance (NHI) Bill sounds ideal – it aims to provide every South African with access to quality health care services, but is it really that clear-cut?

Let’s take a closer look at how it will work.

As a medical aid member, you are currently paying a monthly membership fee. But under the NHI bill, you will see a similar amount added to your tax contribution each month. Medical aid schemes as we know it will (allegedly) become obsolete and South Africa will be left with one health system (instead of our current 2-tier system). 

Although, according to a Q&A released by the South African Health Department, “it is not the intention of Government to abolish private medical schemes if individual members wish to keep them. However, once NHI is implemented, it becomes mandatory for all citizens, meaning no one can opt-out of it even if they still wish to keep their private medical aids schemes”.

Most health care services such as GP visits, prescription medication, surgery, and in-hospital stays will be free of charge and registered doctors will be paid by the South African government.

The bill was first introduced in August 2011 and is expected to be in full swing by 2026, but it’s being rolled out in three phases:

Phase 1: (2012 – 2017) The foundation is laid for the NHI Bill. The NHI fund was introduced and tested in 11 health districts.

Phase 2: (2017 – 2022) Focused on ensuring the bill is functional and the required management and governance structures are in place so that the acquisition of services and registrations can begin.

Phase 3: (2022 – 2026) Mandatory prepayment will be introduced to the public, the services of private hospitals and specialists will be contracted, and the Medical Schemes Amendment Act will be finalised. 

We are currently in the second phase, waiting for the 3rd and final phase to begin in two years.

The government says that the NHI is aimed at helping medical aid members cope with expensive out of pocket costs. But will the quality of our healthcare have to suffer for the sake of affordability? 

Not according to SA’s health department. It says that the NHI bill will see massive investments made to ensure the improvement of the country’s health infrastructure and the following standards must be complied with –

  • Improved hygiene within hospitals
  • Reduced waiting times
  • The elimination of stock shortages (medicine will always be available)
  • Improved safety measures for both patients and staff
  • Added measures to prevent in-hospital infections due to negligence
  • Friendlier and more competent staff

These seem to be targeting the correct pain points currently faced in our public hospitals. Especially when it comes to waiting times, hygiene, and staff competence.

Is it such a good idea to merge SA’s 2-tier health system, though? We’ll let you decide. 

The Pros

  • Everyone, regardless of income, will have access to proper health care.
  • All contributions, along with funds from the country’s healthcare budget, will be combined to pay for health care services meaning that doctor’s consults and treatment will be more affordable
  • You will have access to all your medical records.
  • You will have access to specialists you would otherwise not be able to afford, and
  • Inequality within the healthcare industry will decrease and ideally, be eradicated.

The Cons

  • If you receive an income, you will have to contribute to the NHI fund. 
  • As an SA citizen, you will be required to join the NHI fund, it is mandatory
  • Foreign citizens won’t be covered unless they have travel insurance
  • You will need to adhere to strict rules should you need to visit a specialist
  • You will need to register with a GP who is contracted with the state
  • There will be a tax increase for all employed citizens
  • Unless you are still registered with a private medical aid scheme or are willing to pay cash, you will need to choose from a list of registered GPs.

The Bottom Line

The overwhelming opinion is that the National Health Insurance Bill will do more harm than good by not only harming the country’s private health sector and medical aid schemes, but also damaging South Africa’s economy as a whole.

There are still some grey areas in the bill but ultimately, the NHI Bill will be implemented despite public protest. The question of how successful this system will be remains to be seen.

Get in touch and let us know how you feel about this new bill. 

Are you getting the best deal possible with your medical aid? Visit the MedicalAid.co.za website to view your medical aid options or request a call from one of our expert consultants.

Options for overcoming healthcare inflation

Options for overcoming healthcare inflation

South Africa is home to “80 different open and closed medical aid schemes, with 4.02 million registered members, serving a total of 8.87 million beneficiaries” (Business Tech, 2020). Sadly, further research indicates most South African’s are dissatisfied with their medical aid service provider. Many feel resentful and ripped off when thinking about how much they pay versus how much they still have to pay out of pocket when they need care.

It’s no wonder most South Africans on a private medical scheme are wanting to cut down on these expenses. A medical aid is a grudge purchase that takes a big portion of hard-earned monthly income from its members for what most feel is not adequate cover.   

The South African economy, along with its high unemployment rate means that most of its citizens are unable to afford private healthcare cover, which in turn puts greater strain onto those that can. The harsh reality is that people cannot afford to be without it either.

Cutting down on your medical aid is a major disinvestment

The government system in SA that was designed to provide free or low-cost treatment for all, is failing, and declining by the day and it seems there is little chance that it can continue to provide more than basic primary care. This against a backdrop where there appears to be a growing need for advanced diagnostic services such as MRI or CAT scans. The severe and often life-threatening impact on a patient waiting for service from a government health facility is distressing.

Not many South Africans have R9000 lying around in case they need to pay for an MRI, and by the off chance you need bypass surgery you could find yourself looking for R300 000 or more in your budget. Still wondering if you should give up or cut back on your medical aid?

Do not give up your medical aid

If you have the means, it pays to invest in the most comprehensive cover that you can afford. Of course, you should consider your circumstances. For example, if you are young and in good health, a hospital plan for unforeseen emergencies should prove to be an effective and affordable option.

However, those with children or those with chronic illness and regular healthcare expenses should opt for the most comprehensive product they can afford.

If you are struggling to maintain your medical aid repayment each month you could look at ways to reduce this monthly expense by downgrading to a hospital plan and then taking out medical insurance and gap cover separately. This is a far less risky approach than cancelling your medical aid cover altogether.

Another option is to get an expert to assist you. You could reduce costs by reducing benefits that you do not need.

What you need to know when downgrading

The number of benefits you opt for will determine how much you pay. However, one of the key challenges you may face with trying to downgrade to cheaper cover is that most schemes only allow members to change to a different option once a year, usually towards the end of the year. Changing before then could result in you having to pay back any savings that were advanced to you at the beginning of the year.

Some of the more common downgrade options that you could consider include;

  • dropping down to a cheaper option with limited out-of-hospital cover.
  • opting for a smaller medical savings plan or no savings plan at all.
  • moving to a plan that allows you to pay less if you use medical service providers (doctors) that are listed as part of the scheme’s doctor network.

Before deciding, ask yourself – Are you being driven by price or by need?

Remember, when deciding to downgrade your cover, you must be mindful of your own and your family’s current and possible future needs. Don’t fall into the trap of making a decision based on price alone. Find an option that has suitable cover and that fits your budget. If you don’t have enough cover or the right cover or you haven’t understood the fine print – you could still be crippled financially by an accident or unexpected health crisis.

The three main things to review and consider when choosing your medical scheme:

  • Hospitalisation costs
  • Day to day savings
  • Chronic care: including medication costs

Also Remember PMB’s (Prescribed Minimum Benefits)

In terms of the Medical Schemes Act, regardless of the benefit option you have selected, there is a defined list of benefits/treatments for which all Medical Aid schemes in South Africa have to provide cover for. This includes covering the costs related to the diagnosis, treatment and care of any emergency medical condition; a limited set of 270 medical conditions; and 25 chronic conditions.

It is important to note when it comes to chronic medication that schemes can impose preferred providers and sometimes only pay for generic versions of medication. This means that you need to get your medication from the medical scheme’s appointed service provider, or you will need to fund a co-payment out of your own pocket for your chronic medication.

If you have a persistent condition, check if it is listed as a chronic condition and then check that the medication you use is also covered. Some medical schemes have additional chronic conditions that they cover over and above the 25 that they are obligated by law to cover. These additional conditions could change, so again if you were covered this year, don’t assume it will be covered next year. Rather double check to avoid surprise expenses.

Beware of out of Network penalties

Most Medical Schemes have service provider networks with whom they have negotiated rates to contain costs.  These networks include pharmacies, GP’s, specialists and hospitals. If your healthcare provider is not one of these network providers, you will be liable for a co-payment. 

If the network is convenient for you to use, then changing to a ‘network’ plan could mean substantial discounts on your monthly medical aid premium. If saving money is a major priority for you, then find out if the medical scheme provider you are currently with has a network and if they are in your area. Then if they are acceptable to you, consider downgrading your option.

We can help!

Medicalaid.co.za is South Africa’s best medical scheme comparison website where we help you to find the best medical cover for your healthcare needs and budget (at no cost to you). In three easy steps you can compare your current medical scheme premium or get a quotation comparison based on your needs.

If you want to be able to search for, and compare, personalised medical schemes and healthcare options across multiple service providers with just one click, then visit medicalaid.co.za now.

Everything you need to know about the new National Health Insurance Bill

Everything you need to know about the new National Health Insurance Bill

The national Health Institute has proposed a new bill that will bring drastic changes to the medical landscape of South Africa. Although there are still significant details that need to be finalised there are changes ahead that all South Africans need to be aware of. While we attempt to demystify the new NHI Bill, what is most important to take note of is that these changes will be implemented in a staged manner with the intention to be fully implemented by 2026.

Everything you need to know about the new National Health Insurance Bill

The National Public Health Institute has proposed a new bill that will bring drastic changes to the medical landscape of South Africa. Although there are still significant details that need to be finalised, there are changes ahead that all South Africans need to be aware of. While we attempt to demystify the new NHI Bill, what is most important to take note of is that these changes will be implemented in a staged manner with the intention to be fully implemented by 2026.

We urge South African’s not to panic and make drastic changes to their medical scheme policies. Werner Coetzer, CEO of medicalaid.co.za, has this to say:

“Although reform of our existing healthcare system is necessary, South Africans should not spend their energy worrying about the new NHI Bill. They should rather focus on ensuring their existing healthcare spent is optimised according to their unique needs.”

The first question you might ask is, what will happen to my existing medical scheme? You may keep your medical scheme; however, the Bill proposes that medical schemes may no longer be authorised to cover anything the NHI covers. All South Africans will therefore rely on their medical schemes to assist with the medical needs the NHI does not cover. The Bill makes provision for cover access via authorised referral pathways; if these pathways are not adhered to, the Fund will not cover services. This means that for all practical purposes, schemes will be able to cover services in this instance.

At a recent conference held by the Hospital Association of South Africa, Dr Anban Pillay, Deputy Director General for Health Regulation and Compliance with the country’s National Department of Health, was quoted as saying that people will still be able to choose whether or not to make use of the NHI and will still be allowed to seek private medical solutions. The catch is that regardless of choice, there will still be a requirement to contribute to the NHI through taxes.

So, if the NHI doesn’t cover everything, what will it cover?

Since the new NHI Bill is still in the early phases of its implementation it is unclear what the Bill is going to cover. It has been stated that “comprehensive healthcare services” will be provided free of charge and there will be no co-payments. The new NHI Bill has stated, however, that there will be no financial assistance for conditions where “no medical necessity exists for the healthcare service in question”.

What does all of this mean if I need to see a specialist?

The Bill could be interpreted that by using the proposed referral pathways, access to specialists is possible, although how, who and where is unclear. Despite your having to pay a rather hefty tax contribution to support the new NHI Bill, it is strongly advised that you keep your medical scheme. While the exact tax contribution that will need to be made has not been finalised yet, it is important to note that there are still options for South Africans when it comes to medical schemes.

The new NHI Bill has been heavily criticised and branded a profound ideology. In theory it suggests a larger percentage of the South African population will have access to healthcare, which is a concept being heavily emphasised to the public. President Ramaphosa had this to say about the new Bill,

“It provides for a number of key elements that we would put in place to meet the constitutional imperatives that we need to provide healthcare services to all South Africans, irrespective of their socio-economic background, within the available resources.” Some South Africans have predicted that this Bill will drive our doctors away to seek better salaries and working conditions, which will lead to a crisis in healthcare. There is also speculation that the concept of a single buyer of services proposed in the Bill will lead to corruption and ultimately failure of the health system in South Africa.

Despite the major concern of a brain drain, there are other concerns:

  1.  The public healthcare system is already not functioning efficiently. Although National Health Insurance promises to address the situation, many feel there is not a solid enough foundation in the public healthcare system to sustain this zealous project.
  2. The state will prescribe doctors for South Africans, meaning they will be taking the choice of preferred health professionals away from South Africans.
  3. There will be a huge economic impact, which seems to have been overlooked. The NHI Bill will cause many individuals working in the private healthcare sector to lose their jobs. Medical schemes all over the country will take a hit too.
  4. Worst of all, to reiterate, there is a risk that the most talented and able doctors will leave the country in search of better prospects.

Despite the sceptics, many South Africans are relieved as  the Bill promises to equalise access to healthcare. “I would like to say that the NHI is here to stay. Whether people like it or not, it’s going nowhere,” said Ramaphosa in his address at an African National Congress Women’s League event.

Not only will the NHI benefit South African’s who would not otherwise have access to healthcare, but it also prevents the exploitative cost of private healthcare in South Africa, with some doctors and specialists charging much higher rates than the prescribed medical scheme rates.

South Africans are worried about how this will affect the quality of medical care in South Africa, and the burning question is who is going to pay for all of this? Well, the taxpayers, of course. They will be charged an amount “in accordance with social solidarity” through income tax, payroll taxes from employers and employees, as well as a surcharge on personal income tax. Many of the existing grants currently in place will also now be contributed to the NHI’s overall fund.

South Africans have expressed sharp criticism about the new NHI Bill and have raised many concerns; however, this does not guarantee any changes to the NHI Bill being passed. The only thing we can do now is to evaluate our medical schemes and prepare ourselves for what is to come by making sure we are covered for the procedures and doctors not covered by the NHI.

“We at medicalaid.co.za are constantly monitoring the progress of the roll-out of the NHI and will make it our mission to keep South Africans informed and guide them in their future medical scheme decisions,” says Coetzer.

Comprehensive medical scheme comparison website www.medicalaid.co.za is a well-respected and trustworthy comparison site that reviews SA’s top medical schemes in accordance with the parameters you set.

You can read more on this topic here:

https://www.news24.com/SouthAfrica/News/the-arguments-for-and-against-the-nhi-20190819

https://www.thesouthafrican.com/news/president-ramaphosa-stands-by-heavily-criticised-nhi-bill/

Medical Aids in South Africa - Too many, too complex.

Medical Aids in South Africa – too many, too complex

We can all agree that your health is not something to be taken lightly, placing great importance in the process you follow when choosing the right medical aid for you and your family. This article provides you with an overview of the South African medical scheme landscape. By the end you will have a much better idea of what to look for in a medical aid.

With over 147 private medical options from 21 Open Medical Schemes in South Africa, choosing one can be confusing and time consuming.

Medical aid may feel like a grudge purchase, especially since private medical aid premiums could take up to 10% (or more in some cases) of your monthly salary. It’s a difficult concept to grasp when everyone in your family is healthy, but you should try to see your medical aid as an investment for future health. For this reason, it is important not to base your medical scheme decision on price alone. Settling for the cheapest medical aid you come across is not a recommended strategy. There are various factors to consider in order to make an informed decision.

As a member of a medical aid you may expect cover for the following healthcare services:

  • Day-to-day benefits: GP and dentist visits, specialist consults, as well as examination, diagnosis preventative care, and treatment of diseases.
  • Medicine: Chronic (e.g. diabetes) and acute medication (e.g. colds and flu); and
  • Major expenses: Emergency hospitalisation, ambulance services, maternity benefits, and mental health management.

Unfortunately, not all medical scheme options are equal. There are four different types of plans that you could choose from. Each has its own list of what’s included and what’s excluded. Here is a basic guide of what to expect:

  1. Network options – For individuals and families with young children that need to visit the doctor more often but can’t afford a comprehensive medical aid. This type of plan includes basic day-to-day cover at affordable prices with specific network providers and in-hospital expenses submitted by network service providers. Note: the network of providers differs from scheme to scheme.

  2. Basic hospital plan – Best for active, healthy families who take responsibility for their own day-to-day health but want the peace of mind that hospital expenses will be covered. This type of plan includes in-hospital expenses submitted by service providers and excludes emergency ward treatments and any day-to-day medical expenses.

  3. Hospital plan with savings – A great option for individuals and families wanting peace of mind that hospital expenses will be covered and those wanting a medical savings for day-to-day medical expenses in addition to hospital cover. Here you pay a fixed monthly amount into a medical savings account. The full amount becomes available in advance for medical expenses incurred for that year. This type of plan includes in-hospital expenses submitted by service providers and day-to-day medical expenses.

  4. Comprehensive plan – This option is for Individuals and families that want comprehensive cover without a savings benefit. It includes almost all medical expenses, in-hospital benefits, day-to-day medical expenses and chronic medication and excludes a medical savings account.

As you can see, the medical aid landscape in South Africa is complex. Therefore, before shopping for medical aid quotes you should review your family’s current and future health status, age of family members to be covered, unique healthcare needs and how important the healthcare services listed above are for your specific situation. In addition to this, you will also want to consider the following:

  1. Restrictions (cases or situations that the scheme won’t cover)

    Again, each medical aid scheme and option is different. As an example, most medical aid schemes won’t pay for cosmetic surgery (except for emergencies i.e. accidental disfigurement). They also don’t cover anything relating to obesity management, as obesity is seen as a lifestyle condition that can be managed by the patient. These are just two examples. Not all medical aids have the same benefits and exclusions, some cover conditions others won’t. Restrictions are dependent on the type of plan you chose and is often linked to how much you spend. Find out about these exclusions upfront, before making your choice.

  2. Annual funding limits

    Annual funding limits apply to all medical aids and refer to an, often, set amount paid by the medical schemes for the member’s in- and out-of-hospital expenses. Nobody ever thinks they are going to end up in a hospital but in the event that it happens, you wouldn’t want unforeseen hospital expenses to set you back financially. Having good hospital benefits could be seen as the most important decision regarding your choice of medical scheme option. In addition, you may consider adding GapCover to your plan for even more financial protection against in-hospital specialist bills.

  3. Network limitations

    Most medical schemes have an established working agreement and negotiated rates with a specific network of health practitioners (doctors, specialists, dentists, and hospitals) to treat its members. Choosing to join a network option can save you on monthly premiums, however, note that you could be penalised or not covered by your medical scheme if you use a health practitioner outside of this network.

  4. Exclusions

    When joining a new medical aid scheme, consumers often overlook factors such as being refused membership based on your age or current medical status. Medical schemes reserve the right to exclude pre-existing medical conditions from cover for the first 12 months of membership. This can feel like an eternity for someone that is in desperate need for medical cover. In most cases, the first three months after joining a medical scheme is considered a waiting period during which a member cannot claim for any medical expenses – consider this when switching form one scheme to another. Also note that medical schemes have the power to impose a ‘Late joiner fee’ on new members aged 35 and older. (This only applies if the person in question was not previously a member of a medical aid or those who have not belonged to a medical aid scheme for a specified period prior to April 2001.)

Medical jargon is confusing

It is imperative that new and existing medical aid members familiarise
themselves with the terms, conditions and exclusions of their chosen medical
aid benefit option before signing any paperwork. Each medical scheme has its
own set of rules and as a consumer, navigating and understanding those rules
and the accompanying jargon can be next to impossible without expert help; you
could very easily make the wrong choice. It is therefore recommended that you
use an expert comparison site such as  www.medicalaid.co.za  to help you find and compare
medical scheme benefits and price. Not only will it save you time, but it will
also give you options that you may not have even considered when undertaking
your own research. You don’t know what you don’t know, so turn to the experts
in the industry to help. Best of all, any comparisons done on the site are free.

Debunking myths associated with ADHD and finding a Medical Aid that can support this chronic condition

February is that time of year when back to school excitement diminishes and we begin to see how our children adapt to their new environments and any challenges the new school year may bring. In some cases, parents anxiously await a phone call from the class teacher, to discuss “Timmy’s” concentration issues. All too often, parents are urged by teachers (with no medical background) to consider medication so that their “Timmy” can fare better in the schooling system.

According to News24 South Africa has one of the highest prescription rates for ADHD medication. Many disorders can become doused in stigma; ADHD is no exception. Drawing on the work of Dr. Sharon Saline; here are four myths about ADHD that have been debunked.

Myth One: ADHD is not real and is a recent psychiatric invention.

ADHD is very real. Parents with ADHD children can speak out about this. Despite what many may think it is classified as a chronic condition marked by persistent inattention, hyperactivity and sometimes impulsivity. ADHD begins in childhood and is a biologically based condition. It is not a fad and has been documented in medical literature since the early 1900s.

Myth Two: ADHD is a lack of willpower – kids could focus if they really wanted to.

ADHD manifests in a variety of challenges relating to: impulse control, planning, organisation, motivation, working memory and emotional regulation. Chemically this is as a result of lower levels of norepinephrine and dopamine. This makes it extremely difficult to focus on things, especially if those things are perceived as uninteresting or unfulfilling.

Myth Three: Only boys have ADHD.

When ADHD presents, boys tend to be more hyperactive and girls tend to be more inattentive. This means diagnosis of boys is higher because hyperactivity is more identifiable than inattention. Children who appear to be doing ‘well’ are overlooked until ADHD symptoms appear later in life.

Myth Four: ADHD is over-diagnosed, and medication is over-prescribed.

While there is a very real factor fuelling this myth, namely, when people are not given a thorough examination, they can be misdiagnosed with ADHD without ruling out other conditions which may manifest similar symptoms to ADHD. Therefore, a proper, detailed assessment is essential. There is an increase in diagnoses, not due to ‘over-diagnosis’ but rather more knowledge on ADHD and its manifestations.

More on proper diagnosis:

A psychologist, a psychiatrist, a neurologist or a family physician are the medical professionals you would seek out in order to get a proper diagnosis of ADHD. Since ADHD shows symptoms that can be related to other circumstances it is essential to see a specialist regarding the matter. It is also essential to know who isn’t qualified to diagnose ADHD, namely, teachers, other parents and other students. Not only does the diagnosis need to be done by a specialist, it is important to choose a specialist that suits you. ADHD is a lifelong journey. Once you find a specialist you will need to keep going back to that specialist for check-ups and new scripts – since ADHD medication is a schedule 6 medication, a new script is needed every month – so it is essential to find a specialist that suits your needs and budget.

What about ADHD and your Medical Aid?

In terms of the Medical Schemes Act, regardless of the benefit option you have selected, there is a defined list of benefits/treatments for which all Medical Aid schemes in South Africa have to provide cover for. This includes covering the costs related to the diagnosis, treatment and care of any emergency medical condition; a limited set of 270 medical conditions; and 25 chronic conditions.

Since ADHD is classified as a chronic condition, one would expect it to be covered as such by your medical aid as a prescribed minimum benefit. Unfortunately, this is not always the case. In many instances, medication would need to be funded from your medical savings or out of your pocket. This could amount to as much as R12000 per year, excluding any script fees or specialist appointments.

If you have a child with properly diagnosed ADHD, then you need to find a medical aid that can give you the best possible support?  Some medical aids regard ADHD as a chronic condition where you will receive chronic benefits to age 18 (Fedhealth), others don’t (Discovery)!

So, if you have a child with ADHD, check if it is listed as a chronic condition by your medical scheme and then check that the specific medication you use is also covered. Also, important to note when it comes to chronic medication, is that schemes can impose preferred providers and sometimes only pay for generic versions of medication. This essentially means that you need to get your medication from the medical scheme’s appointed service provider or you will need to fund a co-payment out of your own pocket for your chronic medication.

To find out if your medical aid covers ADHD visit www.medicalaid.co.za and get in touch with one of our specialist consultants.

It’s time to do an annual review of your medical aid plan

Decoding your medical aid terms and conditions and associated costs is not an easy task. As we approach the end of November, time is running out to decide which medical scheme and plan will best suit your needs in 2019.

Here are a few pointers for you to consider:

 

  • Before starting your research, remember that you get what you pay for

Medical Aid Schemes operate on the principle that the contributions received from members should cover any claims paid out. The way to control this is to limit the benefits based on what you can afford to pay. This is why there are so many varieties of plans offered at different price points. There is a direct correlation between cost and benefits – the more the plan costs the more the benefits. As a guide, consider how often you may need to use your medical aid. The more frequently you use your medical aid, the more comprehensive your plan will need to be. Be cautious of very cheap plans with hospital cover – you get what you pay for, and will no doubt have a limit in your hospital cover or a massive co-payment. The better plans have unlimited hospital cover which means you won’t have to leave after a few days, allowing you to stay for as long as the procedure or recovery period requires.

  • Don’t make hasty decisions based on immaterial value adds

While medical aid loyalty programmes have become a big attraction for some (with cheaper movie tickets and gym memberships), be careful not to make this the sole driver when deciding on a medical aid. These are just ‘bells and whistles’ and can distract you from some of the not so great aspects of your medical aid plan. All these ‘nice to have’ benefits won’t pay for your medical bills when you need it.

  • Start by understanding the cover you already have and how it may change for 2019

It’s no secret that the average consumer in South Africa is feeling the pinch of a tough economy and may be looking for ways to reduce monthly living expenses. The following average weighted medical aid premium increases were announced for 2019:

 

  • Bonitas – 8.9%
  • Bestmed – 9.9%
  • Discovery – 9.2%
  • Fedhealth – 8.4%
  • Genesis – 6.5%
  • Momentum Health – 10.7%
  • Medshield -14.5%
  • Topmed – 9.9%

 

Unfortunately for the consumer, all these increases in membership contribution rates are significantly higher than general inflation which is currently at 4.8%. Also bear in mind that schemes need to contain their costs in the face of increasing claims, and in some instances may have changed some of the benefits you have enjoyed on your current plan. For this reason, an annual review of your plan is essential. You won’t want to find out down the line that you are no longer covered for something that you were covered for before.

  • Decide what benefits are the most important to you and your family for 2019

Most people choose their medical plan based on cost, the levels of medical cover provided, day-to-day limits on medical expenses and chronic benefits. While this is not wrong, there are some other factors to consider as well. Be sure to study all the benefits in line with your needs and then compare costs. Avoid choosing on cost alone.

Administration – Get an idea of who administers the scheme and if they have a good track record in processing claims. On occasion, you may need to fund a doctors account upfront. You don’t want to be in a situation where it takes months to get your money refunded.

Reimbursement Rate/Coverage – Most schemes pay claims at between 100% to 300% of their own Medical Scheme Rate which is created using the National Health Reference Price List (NHRPL) as a guideline. If you need to settle for a plan with lower coverage, then you might want to factor in gap cover, an affordable insurance product that covers the shortfalls on in-hospital specialist expenses.

Exclusions – Medical plan brochures are great at punting the benefits of the plan, but what about exclusions? These are as important in terms of what is covered, and this can change from year to year.

Co-payments – Co-payments on certain procedures are common but often overlooked when choosing a medical aid plan. Nobody expects to go into hospital or to undergo certain procedures. However, investigating these upfront as part of your annual review is critically important. Co-payments are expenses that you will have to fund out of your own pocket should they occur. Co-payments differ from scheme to scheme and sometimes depend on whether the procedure is done in or out of the hospital.

Preferred Provider Networks – More and more medical schemes are negotiating preferred rates with their own network of doctors, specialists, pharmacies and hospitals in order to contain costs. Using a doctor or provider outside of this network could result in penalty co-payments and/or claim rejections. Before you choose a plan with these stipulations, first make sure your preferred service provider is covered and/or part of the schemes network.

 

In summary, to find the right medical aid scheme and plan for your needs will require thought and time. You need to be comparing at least five of the top medical aids in South Africa before deciding.

If all of this seems too overwhelming, there is an easier way. Medicalaid.co.za has an instant comparison tool that allows you to compare benefits and price all in one place. The comparison looks at a monthly premium, hospital choice, overall annual limit, cancer cover, reimbursement rate, day-to-day cover, benefits, MRI/CT scans, maternity benefits and chronic cover.

This is a great way to get started and can save you a lot of time. Visit www.medicalaid.co.za now and make an informed decision for 2019.