Your medical scheme options for 2015

By Staff Writer
Before any well-deserved holiday can be had, many of the 8,7 million people who are medical scheme members of some 83 medical schemes in the country first have to decide on their benefit options for the new year, said the Council for Medical Schemes (CMS).
 
The CMS advises members to not only compare prices of schemes, but to choose the medical aid scheme which will benefit their family the best.
 
"It is important to choose the right benefit option not only based on price but by doing research to ensure that the scheme is most likely to meet the future healthcare needs of you and your family," said Daniel Lehutjo, acting CEO and Registrar of the CMS.
 
Scheme options
 
"It is essential that principal members read and familiarise themselves with all the material such as new benefit options to change plans provided by schemes," said Lehutjo.
 
Members are advised to read all the benefit options to better ensure they understand what their medical aid will cover.
 
Furthermore, Lehutjo said that members need to take a medical aid that will cover their specific needs, and also take into account what they can afford.
 
"If you are unsure, call the scheme to explain any changes, limits, benefits and other relevant information," said Lehutjo.
 
However, medical aid schemes can sometimes leave a member paying high premiums without all the cover they need.
 
"Some medical aid plans don't always provide more benefits in the areas that you may need them and the money that you would have spent on the higher premium may be better placed in a savings account/investment to be used if needed," said BDO South Africa in a press release.
 
"Most medical schemes have posted their increases for 2015 already. The CMS generally limits increases to Consumer Price Index (CPI - which is currently at 5.8%) plus 3%, so most schemes' increases would be in the range of CPI to CPI plus 3%.
 
"However, where there is a significant change in benefits on an option, premium increases may differ from this general range," said Heidi Kruger, from the Board of Healthcare Funders. 
 
Furthermore, if a member has other medical requirements that are not covered by their medical aid scheme, they can look at getting gap cover to make up the difference.
 
Gap cover policies cover the difference between what medical professionals charge and what medical aid will cover.
 
Scheme information
 
The registered rules of medical schemes are that they have to fully disclose detailed information regarding the relevant benefits and contributions.
 
It is essential that members obtain the rules of the scheme or a summary thereof to verify all information relevant to enable them to make an informed choice.
 
This same advice is for anyone who is looking to join a medical scheme for the first time. By visiting the medical aids website, or talking to one of their consultants, members can find out any information they might need about their medical aid scheme.
 
Tips of finding a scheme
 
Identify a few schemes and request information about their benefits, contributions, limitations and exclusions.
 
Compare this information given to see which one meets the needs of all the members. Information on benefits can be found on the medical aid schemes website.
 
Besides the healthcare benefits also find out what the schemes reserves are (how well they can financially meet all their obligations), and non-healthcare expenditure, such as administration costs, to ensure they are in good financial health, advised Lehutjo.
 
"Understand what prescribed minimum benefits (PMB's) are and under what circumstances the chosen scheme provides such cover for you. Here you can look at designated service providers and their proximity to you as well as other networks that provide benefits to members," said Lehutjo.

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