Duncan Barker of Serala Financial Services believes that many members of medical schemes are not aware of how to make the most of their benefits and are therefore losing out.
“Most clients don’t use their networks effectively. My main goal when taking on new clients is to make them aware of how their medical aid works. They often come when they are upset with something that their plan is or isn’t doing.
“Often it is a case of just understanding how it works, rather than that there is a problem with it.” He says it is often better to stay on the current medical scheme and learn how it works.
“There is no such thing as a ‘best’ medical aid. They are all the same.”
Barker says chronic benefits are often misunderstood.
“Too often I see clients that are not using their chronic cover as per scheme rules or don’t even realise that all medical aids cover chronic benefits.
“I have clients that are paying for these medicines out of their pockets and not claiming from their medical aids at all.
“Either this is because they have just not done it, or mostly it’s because they have tried and been told it isn’t covered.
“All they would have to do is change to the generic- or ‘formulary’-based option and it will be paid for.”
Here are seven tips to make your medical savings last longer:
1. KNOW YOUR PLAN
Understand what you’re covered for, at what rates and with which providers. Does your plan cover you at the medical scheme rate or at a higher rate? Does your plan require you to make use of a hospital or pharmacy network? Refer to the material you receive from your medical scheme, use their website and talk to your financial adviser about what your options are.
2. KNOW YOUR DOCTOR’S RATES
Patients are often embarrassed to discuss money with their healthcare provider, but when you make the appointment, ask what rates your doctor charges and whether you’ll be liable for any co-payments. That way, you can make informed decisions about how you’re spending your healthcare funds. If affordability is your greatest concern, it might be better to shop around for a provider who charges scheme rates, but if choice is more important to you and you’re happy to pay more, you’ll know upfront exactly how much.
3. TAP INTO NETWORKS YOUR SCHEME MAY HAVE
Some medical schemes have network arrangements in place with healthcare professionals. By using a network, the scheme pays the professional directly, reducing administrative hassle and keeping costs down for you. The Discovery Health Medical Scheme, for example, has an extensive GP network where members are covered in full for doctors’ consultations. We recommend that our members call us or visit our website before they see a healthcare professional, so they know which of these are part of a network.
4. IF YOUR SCHEME OFFERS DIRECT PAYMENTS WITH CERTAIN SPECIALISTS, YOU CAN BENEFIT TOO
For example, Discovery Health Medical Scheme has direct payment arrangements in place with most of South Africa’s specialists on most of its plans. If you see one of them, you won’t be liable for any co-payments. If you choose to see another specialist, you may need to pay upfront or pay a portion of the costs yourself – depending on your plan. Find out what your options are. Don’t be afraid to discuss and agree rates with your specialist.
5. CHECK FOR FULL-COVER ALTERNATIVES
In the case of medicine for a chronic illness, schemes often have formularies – lists of medicine that are covered in full by the scheme. Check with your doctor or pharmacist if your prescribed medicine is covered in full and ask about options if not.
6. PAY IN CASH FOR OVER-THE-COUNTER MEDICINES
If you have a medical savings account, don’t claim for items not normally covered by medical schemes, for example over-the-counter headache tablets, cough preparations, etc, from your savings. Paying cash will help the money in your savings account last longer, so you have funds available for more serious, more expensive out-of-hospital treatments.
7. STAY HEALTHY!
It seems obvious, but people often overlook the fact that by taking care of their health, they can reduce their healthcare costs in the long term. Make use of your scheme’s preventive screening benefits for regular health checks and live a healthy life. In the case of Discovery Health Medical Scheme, members have access to a range of preventive screenings funded by the scheme. Members can join Vitality, which rewards them for being healthy.
- Source: Duncan Kotze, head of research and product development at Discovery Health