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What to consider when choosing medical scheme cover for 2022
MONEY BASICS
with MARTIN HESSE
THIS is the time of year when medical schemes typically have their window period for members to switch plans (known in the industry as “options”) if they want to, either by upgrading to a more expensive option that offers more benefits, or by downgrading to a cheaper one that provides a lower level of cover. The window period differs among medical schemes, but most will give you until the middle of December or to the end of the year to change options. Your scheme will probably by now have issued new brochures detailing all the details of benefits and contributions for next year on each option in their range. It may be laborious, but it is worth going through these thoroughly, checking any changes in benefits on your current option,
as well as comparing options if you want to change. Schemes with better websites have handy tools for comparing options. To get the best value for money, you need to compare option contributions and benefits against what you paid this year, both in contributions and out of your own pocket, weighing up whether to contribute more by switching to a higher option (and pay less out of your own pocket), or to contribute less by switching to a lower option (and self-fund a higher proportion of your expenses). You can also look at ways to save, such as switching to one of the increasingly popular network options whereby you are restricted to the use of healthcare providers on the scheme’s network. Here are some of the things you
should consider when assessing your medical cover for next year: Benefit limits Your option will have an overall benefit limit for the year as well as subcategories with their own annual limits. Check on the changes to these limits compared with last year. Limits on cancer treatment (oncology), in particular, should be noted. Prescribed minimum benefits (PMBs) Your scheme may appoint one or more designated service providers (DSPs) for the diagnosis, treatment and care of PMB conditions, and a list of these providers should be available. If you choose not to use the DSP, the scheme may charge a co-payment.
