Why it is so important to have medical aid cover

Why it is so so important to have medical aid cover

FADIA ARNOLD relates her search for a medical scheme to cover the birth of her child

AFTER being tenderly nudged into the real world when I turned 18 by my parents removing me from their medical aid, I spent the next decade feeling that if I rarely, if not ever, used my parent’s medical aid then surely I could survive just fine on my own without it.

Cut to my honeymoon positive pregnancy test at 32 years old, I immediately panicked that I did not have medical aid and my husband, who had just moved jobs at the time, had not yet had the opportunity to place me on his employee benefit medical aid as a beneficiary. I had heard horror stories from friends and family who had not had any medical aid as a part of their birth plan and being bombarded almost immediately subsequent to birth with unaffordable hospital bills they simply could not pay, resulting in the debt having to be collected by alternative means.

The hunt for a medical scheme I had quickly started researching different kinds of medical schemes; however, the task was daunting as each medical scheme had different options in respect of monthly cover for chronic medication inclusive or exclusive of a hospital plan and gap cover. Some schemes only included hospital cover and most did not include gap cover. Gap cover, which I was clueless about and had never heard of, was to be purchased separately or at an additional price on top of the medical aid cover price.

Nihaal Kamedien, co-founder and director of Platinum Medical Administrators, a company offering full medical practice management training as well as professional consultancy and advisory services for medical practitioners and specialists, explains that gap cover exists “to ensure that any shortfalls in hospital fees and not covered by a patient’s medical aid scheme are covered so the patient is not out of pocket personally without due warning”.

Kamedien further states that gap cover could ensure “extra coverage of three to four times more than your medical aid will pay out for a hospital stay” and that “the sad reality is that far too many medical aid patients only become aware of gap cover in the event that there is a shortfall in their hospital and or medical specialist fees and are shocked and surprised when asked to cover the shortfall privately”. Accordingly, when deciding which medical aid scheme is most personally and financially fit for you and your family, ensure that you enquire with your medical aid scheme about their gap cover options.

In terms of my own personal journey regarding the best medical aid for my birth plan, I initially chose an affordable hospital plan for professionals (any individual with a bachelor’s degree in any field). I found the sign-up process easy and the assistance top drawer. They further agreed to cover the full hospitalisation stay for the birth at the hospital of my choice as well as no extra cost should there be an emergency Caesarian section, which there was. Even further, they agreed to cover any complications resulting from the pregnancy, which is a pre-existing condition often not covered by medical aid schemes if the patient was not signed up and covered at the time of conception.

However, after all the runaround to obtain my own medical aid, my husband’s staff medical aid under his new employer finally fell into place with the same privileges, and it made more sense financially as a family to be covered that way instead.