How to pick a medical aid plan

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Trying to pick a medical aid is a thorny task. It is much trouble to go to, and it is very important for you and your family. Getting help from family and friends may also not be the way to go as everyone has had a bad experience somewhere. Just remember that you do not necessarily have the facts. But we have some facts for you.

Reputation

It is advisable to choose a medical aid that has been in the industry for a good long while. Not that it guarantees good results, but it is preferable to the no-name brand medical aids advertised on Facebook. No name and promises galore? Sounds suspicious. Do your homework thoroughly and get quotes from more than one provider.

Any independent broker should be able to give you information on the solvency of the medical aid in question. You do not want to hear the fund is bankrupt after getting surgery. According to the law, the fund needs to have 25% of its members’ annual contribution in reserve.

Budget

This is the second thing you need to take into account when you pick a medical aid. What is the maximum you wish to spend every month? Of course, you want the best medical aid, but that simply is not on the cards for most people. Draw up a budget, ascertain what you can spend every month, and then start looking at which plan to choose. That is why RMA offers a wide range of options to choose from.

Look for value for money

Higher premiums may mean the medical aid plan is comprehensive (Prestige Care and Status Care, as examples), but it does not guarantee all your needs are covered. Ensure the plan covers everything you are likely to have to get checked regularly. By the same token, low prices, while desirable for monthly expenses, may not cover everything you need.

Demographics and Cover

The first step in looking for cover is very sure of what you need from a medical aid plan. Are you a young, healthy professional just starting in the world, or are you part of a family with three children? Do you have pre-existing conditions, chronic medication, or do you travel a lot? You cannot really plan for future health problems, but taking into account your current status is imperative. All plans have specified benefits and exclusions.

Compare page

You should find a page within most medical aid websites that allows you a quick look at the different plans on offer and what they will cost. In RMA’s case, this is our contributions calculator.

Check co-payment amounts

Medical aids do not cover all procedures and treatments in full. Certain amounts need to be supplemented from the patients’ pockets, and you need to take that into account. Co-payments often catch members unaware as they can be expensive no matter your choice of scheme.

 “Network” care

You also need to note that some medical schemes will only pay in full if you use a doctor in their “network”. At RMA, only Premier Care provides a network option.

Investigate gap cover

If in doubt, speak to a gap cover provider – a separate insurance product that can be taken out to supplement shortfalls incurred during hospitalisation or other major medical expense.

Certain medical aid schemes have a reputation for delaying payments, and, as a result, many medical practitioners shy away from these plans. Make sure your scheme handles payments quickly and efficiently to prevent inconvenience and embarrassment.

Benefits

It is vital that you understand your benefits. If in any doubt call contact our client services and have a pen and paper handy.
Investigate underwriting implications. Ensure you understand how medical aids underwrite a new application. Understand how this applies to you as a first-timer or when switching medical aid plans, particularly check the waiting periods during which you cannot claim.
Study the plan’s HIV Cover – It’s important to assess the benefits and cover provided for HIV as it is extremely prevalent in South Africa and makes the person more vulnerable to other diseases and infections.