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.

Recent Articles

Featured Request your credit report from the right bureau

With so many different credit bureaus in South Africa, it may be difficult to decide from which one to request your credit report. We have a look at what you should be aware of when selecting a credit bureau.

Applying for a home loan? Consider the repo rate

When you apply for a home loan, one of your top priorities should be to secure a low interest rate. In order to achieve this, you need to be familiar with the repo rate. We find out more about this.

Effective financial planning as a single parent

As a single mom or dad, it can be challenging to keep up with the ever-increasing expenses of raising a child. We have a look at the importance of setting up a budget as a single parent.

How your credit score impacts your insurance – and vice versa

Since insurance is paid in advance, it may seem unrelated to your credit score. However, these two are in fact linked to one another. We find out why insurers look at your credit score.


Get a FREE flight ticket with Hotel Sky

Price: From R5,200
When: Until 31 January 2022
Where: Johannesburg and Cape Town

Voucher for 2 special at Bakwena Day Spa

Price: From R1,798
When: Until 31 January 2022
Where: Centurion, Hartbeespoort and Stellenbosch

Spier Hotel Summer Special

Price: Available on request
When: Until 31 March 2022
Where: Stellenbosch

Latest Guide

Guide to debt rehabilitation solutions