Health insurance for lower-income earners

2012-10-07 10:00
Maya Fisher-French
Medical aid coverage is no longer the preserve of the more well off, writes Maya Fisher-French

Unexpected medical costs can wipe you out financially so insuring for hefty medical bills is an important part of your financial plan.

Medical schemes are fairly expensive and have been seen as the preserve of higher income earners.

Fortunately, medical schemes have introduced medical cover for lower income earners that are based on what you earn.

These plans usually require you to use service providers and hospitals selected by your scheme and will have certain limits.

However, they still provide reasonably comprehensive cover for some day-to-day medical costs while paying for any major medical costs like hospitalisation.

Day-to-day cover typically includes GP visits and basic dentistry such as your annual check-up, cleaning, polishing, fillings, extractions, pain and sepsis treatment, and X-rays.

You are also covered for eye tests and a pair of spectacles every two years.

Prescribed medications that are included on the schemes list of medicines will also be covered.

Hospital costs at a network provider are paid for up to a certain limit and covers the cost of giving birth.

Your take-home medication is usually covered for seven days and some schemes include some cover for  rehabilitation.

Although you are required to use the schemes’ network of doctors and hospitals, the schemes do provide cover for one or two emergency visits to non-network providers a year.

By law, the schemes have to cover all 54 prescribed minimum benefits (PMBs), which mean they will pay for medication and associated medical costs related to those conditions, which include HIV/Aids, diabetes and hypertension.

The monthly premiums are usually determined by how much you earn and some funds offer lower rates if you select state hospitals over private hospitals.

When selecting a fund, make sure you understand the limits and where they apply so that you don’t encounter any unexpected expenses.

For example, some schemes pay for over-the-counter medication if prescribed by the pharmacist while others don’t. Some schemes have unlimited GP visits while others apply a limit of 12 per year.

All schemes have a limit on hospital cover but this can range from R500 000 to R950 000 a year.

Also, make sure you use the services offered.

For example, some schemes offer HIV/Aids counselling or child care advice for the first year of your baby’s life.

Momentum Ingwe
Momentum Ingwe is aimed at individuals earning less than R9?000 a month and is linked to your income. Premiums start at R397 for an individual earning less than R4?900 a month, and up to R3?533 for a family of five where the main member earns R8?900 a month. Premiums are about 20% lower
if you opt for state hospitals rather than the Ingwe Network of private hospitals.

Discovery KeyCare
Discovery KeyCare is a range of entry-level products.

KeyCare Plus and KeyCare Core are for people who earn up to R6?250 monthly and the premiums per main member are R638 and R511 respectively.

Next year, Discovery will be introducing KeyCare Access for R450 a month aimed at those individuals who earn less than R3?900.

The focus is on primary healthcare and provides private GP visits, emergencies and accidental trauma in a private hospital, childbirth and care for newborns in private hospitals, and elective procedures in a contracted network of state facilities.

Fedhealth Maxima EntryZone
Fedhealth Maxima EntryZone is primarily a hospital plan and is not income dependant.

Irrespective of income, the principle member would pay R883 monthly.

The plan has limited day-to-day benefits such as only one GP visit per beneficiary a year although it does include preventative screening care such as cholesterol tests and pap smears.

Due to the focus on hospitalisation, it provides unlimited hospitalisation at network hospitals.

There is post-hospital treatment for up to 30 days and all specialised radiology such as MRI and CT scans are paid by the scheme.

You are able to upgrade to a higher option any time of the year on diagnosis of a dread disease or in the case of a life-changing event.

The Rolls-Royce of medical schemes
On the other extreme, Liberty Health has introduced Prestige, a fully comprehensive medical scheme that covers all your medical expenses from risk cover so you are never faced with unexpected medical expenses.

This option is aimed at executives and people who are too busy making money to have the time to worry about medical admin.

Members are assigned their own private consultant, available 24?hours a day, 7 days a week, who attends to their and their family’s needs.

They will deploy a nurse to perform preventative screening tests such as basic blood-glucose screening, cholesterol testing and blood pressure, all free of charge.

Described as the Rolls-Royce of medical schemes, the premium for a family of four will set you back more than R10?000 per month.