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Category:
Insurance
News /
Medical
Aid / March 2009
Are You Paying More For Less?
Medical
schemes announce their rate increases and benefit changes annually.
Yet do you really understand what this means for you as an
individual? Why are these changes made and will you retain all of
the benefits you signed for at the conception of your medical cover?
Membership
premiums usually tend to rise each year, as a result of inflation
and ever escalating hospital costs, but higher monthly premiums do
not necessarily equate to improved benefits.
Clinton
Alley, Executive Principal Officer for Medshield Medical Scheme,
comments, "It is vitally important that consumers know what they
will be paying out during the year ahead and also what benefits they
can access. Too often members fail to check what changes have been
made to their options and this could have major financial
implications."
To avoid
having claims rejected because benefits have been squeezed or worse
still, having to downgrade to an inadequate option, Alley suggests
you consider the following checklist of tips:
* Each year
ask various schemes for quotations for a package that suits you and
your family needs and compare prices. Alternatively, ask your
broker to keep you up-to-date on what's happening in the market.
* Properly
evaluate your and your dependants' state of health. If any of you
suffer from chronic complaints not covered by a hospital plan, aim
for comprehensive cover that offers generous day-to-day benefits all
year round. If you have sight or dental problems choose an option
that covers them comprehensively.
* Think
about your financial situation. If you earn R6, 000 a month you
can't afford comprehensive cover of R3, 000. Establish how your
family structure will affect your monthly contributions. See which
scheme and option offers the best, most affordable cover and
ascertain your monthly contributions.
* Before you
sign, establish how healthy the scheme's financial affairs are -
brokers or the CMS (Council for Medical Schemes) can help - and
enquire about its record for paying out (ask hospitals if they've
had problems with a particular scheme). You don't want to be with a
scheme that lets you down when you need it the most.
* Read the
fine print of the benefits scale. If at first glance a scheme seems
to payout 100 percent for just about everything you may feel safe,
but pay attention to annual limits.
* Pay
attention to all the exclusions under your option. Several schemes
have instituted levies on specific hospital procedures or simply
don't cover certain procedures or items.
* Insist on
prescribed minimum benefits. The CMS offers a list of all of them,
with descriptions of treatment for chronic conditions that the law
requires every medical scheme to cover.
Medical
schemes should always design healthcare options to suit the varying
needs of their members. And this process is undoubtedly constantly
evolving. As a scheme member however you really need to keep a
close eye on the annual changes made to your option, otherwise you
may find yourself paying over the odds for cover that no longer
meets your needs.
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