10 tips for choosing the right medical aid

The medical aid landscape can be tricky to navigate so it’s best to compare all available schemes and their ranges of plans (benefit options) to find cover that works for your budget and your family’s health. Bonitas Medical Fund offers the following:

10 Points for choosing the right medical aid

1. Analyse your healthcare needs No two people or families are alike – medical needs differ. So do a quick personal healthcare needs analysis to determine what cover you need. If you have dependants, factor in their healthcare needs too. Factors to consider include: • How often you visit your family visit a doctor or specialist • Over-the-counter medication and chronic medication required • Chronic conditions like high blood pressure or diabetes • Specific conditions like cancer, HIV or renal failure • Dentistry • Optometry This will help you decide whether you need a comprehensive medical aid plan or more basic cover, such as a hospital plan.

2. Read the small print Benefits vary from plan to plan, so establish what is and isn’t covered and look at whether the option offers additional risk benefits, which can save on dayto-date expenses. These may include free wellness screenings (blood pressure, cholesterol, blood sugar and BMI measurements) through to mammograms, pap smears and prostate screening. In some cases they extend to maternity programmes, dental check-ups, flu vaccinations and more.

3. Managed care options Assess what the medical scheme offers in the way of managed care programmes to help members manage severe chronic conditions such as cancer, diabetes and HIV/ Aids.

4. What about savings? Medical savings are a fixed amount a scheme gives you at the beginning of the year to cover day-to-day medical expenses that are not covered under your risk benefits. There are ways to maximise your savings, but first you need to know what your annual allocation is.

5. The day-to-day details Look at what the scheme suggests as a way to make your benefits last, bearing in mind the following: • Some plans require you to use specific GP and hospital networks and have a list of designated service providers (DSPs). These keep costs down because the scheme will have negotiated special rates with these service providers. Check the network in your area before making a final decision. • Must you be referred to a specialist by your GP? • Does your medical scheme plan offer additional GP consultations, which it will pay for, after you have exhausted your day-to-day benefits?

6. Virtual care and technology Technology and virtual care are being embraced by medical schemes and members. Check what is offered on the plan you’re considering and whether you want access to your benefits 24/7.

7. Age impacts your decision • If you have young children, ensure the option you select provides sufficient child illness benefits. • If older, select a plan that covers chronic conditions and provides sufficient in-hospital cover in the event of hospitalisation

8. Ensure affordability Consider all the costs involved before you make your final decision, such as: • Monthly contributions: a rule of thumb is that contributions should not exceed 10% of your monthly income. • Co-payments. This is part of your healthcare expenses that you are liable for when making use of certain medical services. These co-payments usually apply to specialist or elective medical procedures and will differ from one medical aid scheme to another.

9. Waiting periods and exclusions The Medical Schemes Act and the specific scheme’s rules determine what waiting period you and your family will be subjected to if you join a scheme, and what exclusions may apply. Each scheme is different, so you need to enquire with the relevant scheme about their exclusion list and waiting periods.

10. Brokers Using a broker doesn’t cost you anything. An independent broker will help you work your way through the different options and help choose the medical aid plan best suited to your and your family’s needs.