Do you cut your lifeline in hard times?

Knowing what benefits are offered by a medical aid, and which of these you personally need, will help you to make an informed decision about the medical cover you will get the most value from. It's important to be able to know what you'll benefit from, rather than choosing a medical aid haphazardly for the sake of having cover.

A lesson can be learnt from a recent story in a local Afrikaans newspaper about a man who required urgent heart surgery. According to the article, his scheme refused full payment for an internal prosthesis based on the fact that the scheme had sub-limits for such operations. Although the scheme would pay for hospitalisation and other related costs, it would only cover the prosthesis up to his stated benefit limit for internal prosthesis. Knowing this prior to the operation, would likely have influenced the choices he and his family made, demonstrating the importance of understanding exactly what your medical aid offers you.

Leon La Grange, CEO of TeleMed recently explained in an interview that the benefits offered by medical aids are carefully standardised through the Managed Healthcare (MHC) Protocols and Interventions. These protocols and interventions are put in place to protect the medical scheme as well as the members. Good MHC interventions have saved many lives in the past, even if it only meant enhanced quality of life.

La Grange offers three major points to consider when assessing your medical aid. Medical aids urge their members to consult their medical scheme on an annual basis and not just when signing up. This is to help ensure that your medical aid benefits continue to match your changing needs. Why pay for something that you don't need? By doing good research, you could be saving yourself a pretty penny by cutting out any unnecessary costs. Ensure that your day-to-day benefits, as well as your hospital benefits, are suited to your requirements. That includes making sure that you have sufficient cover for when you need it most.

Make sure that you are fully aware of your health status when choosing your medical aid option. Medical scheme members are only allowed to change their options at the end or beginning of the year, so if you need more comprehensive cover in the middle of the year, members will not be able to change to a higher option.

Consulting with a healthcare broker and asking them to explain the details of the products will enable you to make the informed decision. "Independent brokers should give you an unbiased comparison of medical schemes allowing you to make the best choice based on your health needs," says La Grange.

Article courtesy Mediaweb.co.za