Interesting articles about the Medical Aid industry and Medshield position in it
Posted in Articles   |   July 24th, 2018
If you plan to sign up with one of South Africa’s medical aids, then obtaining a few quotes will be a good starting point. However, you will also need to look beyond the figures that apply to the monthly premiums if you hope to gain meaningful insight into the pros and cons of a given product.
All products in this category are designed to assist the members of a scheme to cope with the often considerable expenses that inevitably arise from most forms of private healthcare. As such, the contract entered into by you as the member will detail the full extent of any liability undertaken by the scheme, as well as the responsibilities that are incumbent upon yourself. Both of these factors will need to be examined in detail and carefully evaluated in any comparison that you make between various medical aid quotes.
It may help to increase your understanding of a given product if you know more about how its benefits are determined. In some cases, these benefits may be mandatory and a legal requirement for any product made available by South Africa’s many schemes. For example, the Medical Schemes Act of 1998 made it compulsory for all schemes to provide full cover for a total of 270 diagnostic/treatment pairs and 25 chronic diseases as well as any emergency medical condition that collectively, are described as prescribed minimum benefits (PMBs). The Act also created a regulatory body, the Council for Medical Schemes (CMS), to ensure the implementation of these PMBs, to handle applications for premium increases, to mediate in disputes between members and their schemes and to advise the health minister on possible improvements. These, at least, are basic benefits that you may rely upon to be covered by all medical aid quotes.
Over and above the PMBs, any additional benefits offered are likely to vary between individual schemes and between the various products that may be available within any of these schemes. In any given product a set of treatments and procedures will be defined along with any corresponding annual limits to which they may be subject. Products differ from one another in terms of both their emphasis and their maximum claimable amounts. For instance, a product aimed at a couple with young children may offer more support for orthodontics than one intended for a single person. Similarly, those aimed at young married couples may well focus on providing maternity and paediatric benefits more prominently than the other products offered from that particular scheme.
When in search of medical aid quotes, it is important to compare apples with apples. For instance, you could certainly save a great deal on premiums by opting for a hospital plan rather than a more comprehensive form of healthcare cover. However, apart from the mandatory PMBs which, incidentally, may require a preliminary waiting period before they can be claimed and are only applicable while hospitalised, it is important to know if the plan you choose offers any additional benefits that could later prove relevant. In addition, you need to be quite certain that you are able to handle all of the potential out-of-hospital costs that are not generally covered by this type of product.
As previously stated, obtaining a number of medical aid quotes can prove to be a valuable exercise. This, however, is only true when they refer to products that fully meet your needs. For this reason making a detailed comparison is essential before reaching a decision upon which your and your family’s future health, as well as your financial position, may soon become dependent. In order to obtain quotations, you could visit one or two corporate offices and speak with a consultant, collect much the same information by means of a telephone call or make your enquiries online. Either the latter may result in a preliminary figure based upon a few basic questions or a call-back and all schemes may require some more detailed questioning and/or a physical examination as a condition of acceptance.
The online method is quick and, if you make use of one of the many comparison sites, it simplifies the process of spotting any relevant pros and cons of the various schemes. On the other hand, Medshield offers a range of seven products to meet the needs and budgets of most individuals. With 50 years’ experience, few schemes are better positioned to provide favourable medical aid quotes.
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