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Category:
Insurance
News /
Medical
Aid /
January 2008
Medical Schemes – What You Didn’t Know
Choosing the right medical scheme could be one of the most important
financial decisions you ever make.
 What many people don’t realise is that once you’ve signed up for the
cover that suits you and your family, you can’t simply pack your
policy forms away in a drawer and forget about them.
It is important to both manage your healthcare cover and understand
some of the procedural requirements on your part. If you don’t, you
could be considerably out of pocket further down the line.
To experience the true value of a medical scheme requires some
forward planning. Herein lies the problem.
We live in an age where much emphasis is placed on the here and now.
Looking to the future is not always an appealing option when demands
on our time and finances mean that we are preoccupied with
day-to-day considerations.
Peter Moyanga (Pictured right), Medshield Chairman, urges South
Africans to think of their medical scheme as a lifelong healthcare
partner, “Keep your medical scheme in mind when planning for the
future and remember that it’s a two-way relationship. Doing your
homework on the scheme’s policy on payment of claims and general
cover can save you time and money.”
Assuming you’ve realised the benefit of medical cover and have found
an option that works for you, don’t make the mistake of forgetting
all about your healthcare partner until you need a claim paid.
Moyanga advises that there are some common problem areas which
members frequently experience, all of which can be attributed to
lack of knowledge on the part of the member. These issues can be
easily avoided and include the following:
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The three month rule:
Most schemes require the member to submit
any claims for payment within three months. It is the member’s
responsibility to ensure this deadline is met. Failure to do so
will result in the claim becoming stale and the scheme will not
cover the costs. A simple rule to remember, but one which
unfortunately catches many people.
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The rate debate:
A medical scheme pays claims at the rate
stipulated by that scheme. The scheme member is liable for the
shortfall resulting from medical practices charging rates higher
than the scheme covers. Some medical schemes will pay for costs
originating from above scheme rates, however this is at an
additional cost to the member. Ask your broker about options
that bridge this gap – you may pay marginally more in your
premium each month, but you’ll be covered for considerably
more.
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Pharmacy fees:
Most pharmacies charge an admin fee when
submitting a medication invoice to your medical scheme for
payment. Most schemes do not cover this fee. You can avoid this
fee if you instead pay cash for your prescription and submit the
invoice to your scheme yourself.
Knowing about issues such as these will enable you to make full use
of your medical scheme cover. But the first step is to realise the
importance of partnering with the right scheme to begin with.
Moyanga encourages South Africans simply to think about some of the
healthcare milestones and resulting financial implications they are
likely to experience in the next few years.
He comments, “Planning for a child or considering the possibility of
you or a family member developing a condition to which you may be
pre-disposed are all potentially expensive occurrences."
"Don’t wait until they happen before you seek the cover that will
save you from financial strain. And once you are covered by a
medical scheme, ensure you are getting the most out of your cover.
It’s what you’re paying for.”
Source: ITInews – Insurance
Times and Investments Online
www.itinews.co.za
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