Medical Aid Opinion South Africa

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    Understand your medical aid policy changes for 2024 and make an informed decision about your cover

    Medical schemes review their policies annually and make changes for the coming year. This may include enhancements to cover, reductions in cover, changes to the way things are covered, additional co-payments and sub-limits, and more. It also includes premium increases, which vary according to the medical scheme and the plan option.
    Source: James White, the director of sales and marketing at Turnberry Management Risk Solutions.
    Source: James White, the director of sales and marketing at Turnberry Management Risk Solutions.

    Understanding these changes and how they affect you is critical in ensuring you maintain the best level of cover to meet both your needs and your budget in 2024 and beyond.

    Increased premiums

    The Council for Medical Schemes regulates increases to medical aid premiums, allowing for an average increase of approximately the Consumer Price Index (CPI) plus 3%. However, as this is a weighted average increase, and CPI fluctuates, this only gives a general indication of what price increases can be expected for 2024.

    CPI is currently around 6%, which means the average medical-scheme contribution increase will be around 9%, but some plan options have lower increases while some are increasing by a massive 20%.

    Changes in cover

    Another thing that changes every year is how things are covered by medical schemes. Again, this depends on the scheme and the plan option. New treatments may now fall within the cover of the medical scheme, and in some cases, benefits may be increased. In others, there may be increases in existing co-payments as well as additional co-payments that will become applicable for procedures that were previously covered.

    There may be increases in the penalty amount for using non-Designated Service Provider (DSP) doctors and hospitals. There may also be additional or increased sub-limits for procedures, and some plans may have additional exclusions that previously did not apply.

    Meeting your needs

    There is no universal change that is applicable across medical schemes and plans, as it is entirely dependent on the option selected and the provider. It is therefore critical to examine your individual plan option and understand what will be changing. This will allow you to find out exactly how much the contribution will increase by for 2024 so that you can accurately budget, and how your cover will be different, and if it still meets your needs.

    Once this is understood, you will be able to make changes if necessary. It will also allow you to see where gaps exist and help you to choose the right gap cover to augment your medical-aid plan and option.

    If downgrading your medical-aid cover becomes necessary, shoring up these gaps with gap cover becomes even more important. However, this is an incredibly complicated landscape, and understanding the changes is not always easy. It is important to talk to your broker to make sure you get the right advice and can make any changes necessary before the end of the year.

    About James White

    James White is the director of sales and marketing at Turnberry Management Risk Solutions.
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