Cancelling your medical aid should be a last resort

It’s the time of the year when medical aids launch their plans and costs for 2021 – the time to make important decisions to ensure that you and your family have access to quality healthcare. The ‘open season’ for medical aids gives you the opportunity to reassess your medical needs and affordability for the year ahead. It’s an important but sometimes difficult decision.

Tough economic times

The last six months have made it even more difficult. When your income is threatened, reduced, or in the worst-case scenario has dried up as a result of the pandemic, deciding where to spend and where to save becomes critical. In circumstances such as retrenchment, or periods of reduced employment, it may be tempting to consider quick-fix solutions and take a break from your medical aid. “But,” says Lee Callakoppen, Principal Officer of Bonitas Medical Fund, “we strongly advise against this.

“South Africans are facing many challenges during this tough time and we are aware of the financial implications the lockdown has placed on everyone,” says Callakoppen. “The pandemic has put a spotlight on the need for quality healthcare and having medical aid will ensure you get exactly that.”

Healthcare costs are high - always about 5% more than inflation and now, more than ever, South Africans will find these costs prohibitive. For example, two weeks in intensive care could cost around R392 340 and in a general ward it’s around R99 201. The alternative is public healthcare.

Getting advice

Callakoppen says, “Deciding on a medical aid plan needs to be an empowered decision. It is imperative that the decision you make regarding you and your family’s health is balanced against the benefits you require and affordability. Medical aid plans can be confusing, which is why it’s important to compare the various options and benefits to ensure you find an option that works for you and your dependants. For people who have a broker, this should be the first point of call to help you make an informed choice.”

Buying down is a consideration, or looking at network options that offer marked savings. The Bonitas Select Plans, for example, are priced 15% cheaper than nonnetwork options. In addition, it is strongly advised that you consider benefit richness against your contributions.

Some tips from Bonitas when deciding on health cover:

Read the small print

It’s important to read all the information about the plans, so that you understand exactly what is covered and what isn’t.

Have a look at your healthcare costs over the past 12 months, including:

• What you spent on day-to-day healthcare expenses

• Was anyone admitted to hospital?

• Did you need to visit a specialist?

• How often did you visit a GP?

• Do you have any chronic conditions?

• How much was spent on dentistry, optometry and overthe-counter medicine?

• Did you use up your day-to-day benefits and/or savings in the year?

• How much did you pay in copayments and/or deductibles?

• Also consider once-off costs that won’t come up again soon (childbirth) and those likely to come up again (such as flu).

Age impacts your decision

• If you have young children, select an option with enough child illness benefits

• Check the maximum age of child dependents

• If you’re older, select a plan that provides sufficient inhospital cover in the event of hospitalisation, and that covers chronic conditions.

Day-to-day detail

Medical aids are not-for-profit and belong to their members. For this reason, they have to ensure they contain costs for the benefit of all their members. So it’s important to look at the day-to-day benefits carefully.

Additional benefits

Ask what extra benefits might be available that could save significantly on day-to-day expenses. These could include: Preventative care benefits, ranging from basic screenings (blood pressure, cholesterol and BMI measurements) through to mammograms, pap smears and prostate screening. In some cases this extends to maternity programmes, dental check-ups, flu vaccinations and more. Look at virtual care options on your medical aid and what value you get from them.

Ensure affordability of the plan

When comparing different medical aid options, consider all the costs involved before you make your final decision, such as:

• Monthly contributions - as a rule of thumb, should be around 10% of your monthly income at an individual or household level

• Generally, the lower the cost of the option, the fewer the benefits available to the member regarding medical treatment, healthcare providers and medications.

Comprehensive medical aid or hospital plan?

• A medical aid plan covers members’ healthcare costs, in and out of hospital, such as treatment and medicine – as well as simple day-to-day benefits and hospital cover. The plans have set limits for specific benefits and costs are covered according to the rules of the medical scheme and the member’s option.

• A medical aid hospital plan provides you with basic, yet important medical cover. Hospital plans differ from scheme to scheme but in essence this plan – regulated by the Council for Medical Schemes – includes cover for all your required in-hospital procedures and check-ups. So when you are admitted into hospital for a planned procedure or due to an accident or illness, your expenses are covered, within the limits set by your particular plan. You are responsible for your own day-to-day medical expenses (such as visits to the doctor, specialists and medicine).

DECIDING ON A MEDICAL AID PLAN NEEDS TO BE AN EMPOWERED DECISION

Remember hospital insurance is a completely different animal to a hospital plan. Hospital insurance is not a medical aid but rather provides you with cash benefits that are paid to you while you are in hospital due to illness, an accident or intensive care of convalescence. You are able to use the money however you please, to cover your medical expenses or daily household costs. But your medical bills are for your account.

Co-payments

Medical practitioners and hospitals often charge more than medical aid rates. This means medical schemes seldom cover the entire bill. A copayment refers to the outstanding portion of the account, for which you will be responsible. A copayment varies from one medical scheme to another and is sometimes not necessary if you use a DSP or network hospital. The medical aid can pay between 100%-300% of the medical aid tariffs, depending on the plan you are on. Bonitas offers a wide range of plans, including traditional, savings, income-based and hospital plans.

Virtual care on the up

The pandemic has introduced us to a ‘new normal’. One of the noticeable changes in the healthcare landscape is how members have engaged differently with their healthcare practitioners and medical aids. Virtual care has become an accepted norm, locally and internationally, paving the way for a new era in access to healthcare.

This is supported by members’ expectation of innovation and accessibility, with technology being a key driver. To address this, Bonitas increased the use of technology between members and schemes with WhatsApp and the self-help portal. The good news is that virtual care is being made available to members across all Bonitas plans in 2021. In addition, we are introducing two new plans, driven by technology, intelligence and innovation that offer coordinated virtual care initiatives.

Which option is best?

Callakoppen recommends you complete a quick personal healthcare needs analysis to help you determine the level of cover you need. The interactive Bonitas website allows you to compare up to three plans at a time to help you make a considered decision about the medical cover you need.

Key questions to ask yourself include:

• Does my medical aid offer additional benefits that are paid from risk rather than savings or day-to-day benefits?

• Does my medical aid offer alternatives like virtual GP consultations, chronic medicine delivery and online antenatal classes to deal with the concerns posed by the lockdown?

What will the consequences be for members if they cancel their policies?

Unfortunately, members who resign from the Fund are unable to access healthcare benefits. There are strict rules and regulations governing the medical aid industry in place to protect both members and the financial sustainability of medical schemes.

Cancelling your membership

This should be your last resort. If you do cancel, try to rejoin or join a new scheme within three months otherwise the new scheme can impose:

• A three-month general waiting period

• A 12-month exclusion from cover for any existing medical condition

• Late joiner penalties on all people over 35 years of age.

Why a broker is important

Brokers know the details of the different plans and schemes, which means they can help match you with the best medical cover. COVID-19 retrenchments and reduced salaries mean professional advice is even more important as we go into 2021.

First timer? Callakoppen says that Bonitas has seen a marked increase in queries about joining the Fund since the start of the pandemic. And even though waiting periods apply as normal, with a 12 month’s exclusion cause, COVID-19 is considered a Prescribed Minimum Benefits (PMB) and is covered immediately.

“COVID-19 has highlighted the fact that good health is precious and has forced us all to consider this as a priority over other concerns,” says Callakoppen. “We should never compromise our health.”

www.bonitas.co.za

Lee Callakoppen, Principal Officer: Bonitas Medical Fund