Six tips to stretch your medical aid benefits

December 18, 2021

Lifestyles or Non-Communicable Diseases (NCDs) – such as diabetes – have become an epidemic in South Africa which is why preventative and managed healthcare has become all important. Whether you rely on the public or private healthcare system it is critical that you manage your health and lead a healthy lifestyle, to prevent long term illness. Make the most of your medical benefits, in other words.

Cardiovascular (heart attacks and stroke), cancer, chronic respiratory disease and diabetes are on the increase and responsible for the high cost burden of healthcare. For the around 20% (just under 8.9 million) South Africans who are on private medical aid schemes, managing their medical expenses correctly is important if they want to avoid unnecessary out of pocket expenses and make their medical benefits last longer.It also helps them understand the cost associated with the healthcare services they receive and the benefits associated with the plan they have elected.

Here are the five tips from Lee Callakoppen, Principal Officer of Bonitas Medical Fund on how you can stretch your medical benefits.

1. Get Gap Cover to Avoid Co-Payments

To take care of those co-payment worries, you can take out medical gap cover. That’s an insurance policy to make sure you don’t have to pay exorbitant medical fees out of your own pocket. Use the convenient contact form on this page to get in touch with us about signing up for gap cover.

Gap Cover in 2020 - Medical Aid Benefits

2. Use Designated Service Providers or networks

Medical schemes negotiate preferential rates with providers – known as Dedicated Service Providers (DSPs) – who have partnered with them. This allows schemes to ensure that members get the best quality services at the most cost-effective rate so that the benefits are optimised and the scheme at large is sustainable.

So if you use a network hospital, doctor or pharmacy you will not be charged more than the agreed rate. This will help you avoid co-payments and make your medical aid last longer. So, to reduce co-payments and even avoid them altogether,find a healthcare professional on your schemes network.

3. Go generic to stretch your medical benefits

Use generic medicines which have the same active ingredient, strength and dosage as the original brands and are as effective.Most pharmacists offer a generic option, especially for chronic medication. Medical schemes are more likely to pay in full for generic medicine.

Pharmacistsare also able to provide sound medical advice on problems such as rashes, colds or illnesses that are not severe, simply ask and buy the recommended over-the-country medicine tosave on a visit to the doctor.

4. Managed Care means medical benefits

Some schemes offer programmes to help you manage severe chronic conditions such as cancer, diabetes and HIV/AIDS. These programmes are usually covered from the risk portion of your medical contribution and are not funded from your savings account. They help you use your benefits to maximum advantage while ensuring you receive quality care by using specific providers.

Other benefits – such as maternity consultations, wellness benefits, preventative care and dentistry – are also paid from risk by some schemes. Again giving you more value for money and are in addition to your savings and day-to-day benefits.

Carefully read through what your plan offers and choose wisely to make sure you find the right plan to suit your specific healthcare needs

5. Know the facts

If you do need to be hospitalisedand it’s not an emergency ensure that it’s on your medical aid’s DSP list. Talk to your doctor or specialist to find out all the facts in terms of what they will be charging and compare this to what your scheme will cover. If the difference is substantial, negotiate. Approach your doctor and ask if they are prepared to adjust their fee. Alternatively, you can also check if there are other healthcare providers on your scheme’s network that will charge you a better rate.

You can also avoid the unwelcome surprise of a co-payment or sub-limits by:
Making sure you obtain pre-authorisation
Making sure the medical practitioner uses the correct ICD-10 codes
Checking what additional costs will apply (if any), what costs will be covered andhow you can avoid these.

6. Keep moving

One of the best ways to manage your health and the associated costs, is to live a healthy lifestyle and this includes getting enough exercise. Try different exercise routines and find one that works for you. Whether it is a regular short power walk, playing tennis or soccer, riding a bike or attending a yoga or pilates class, it will be beneficial to your mental and physical wellbeing.

‘Be informed and make good and less costly healthcare decisions,’ says Callakoppen. ‘Your health is important, so take time to research and understand the medical aid plan you are on. Read the information sent to you by the scheme or your broker, including the fine print and,if you don’t understand some of the terms, speak to your broker or phone the customer care line.Understand and know your rights in terms of healthcare cover, this will go a long way in helping you make the most of your benefits.’

All info was correct at time of publishing