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Medical aid increases for 2016 and how to save costs

By Staff Writer
Many medical schemes recently released their price increases for next year. Justmoney looks at the increases that four of the large medical schemes will be implementing, as well as where you can save money with the cost of medical cover increasing.
Four of the country’s biggest medical schemes announced their increases for 2016 over the past few weeks. The increases range between average increases of 8.6% and 10.5%.
  • Momentum Health has announced an 8.6% average increase for its medical scheme options. This decreases to 5.9% if you include their lowest Ingwe income band.
  • Discovery Health will also be implementing an 8.6% average increase to its various medical scheme options in 2016.
  • Fedhealth will be implementing an average increase of 9.9% in 2016. The increases range between 4.7% and 14.5% depending on the medical scheme option that you are on.
  • Liberty Medical Scheme announced an average increase of 10.5% for 2016, with increases between nine percent and 9.5% for most of their medical scheme options.
The need for increases
During the Momentum Health media launch for 2016, the medical aid provider revealed that the average age of the principal member for medical schemes is increasing, which means that not many young people are not joining medical aids. Furthermore, as the age of the principle member increases, so too does the frequency of claims. In order to provide the same benefits to members, medical aid providers are therefore required to increase their fees.
“All medical schemes require new, healthy lives to help cross-subsidise the claims of its older members and to help counteract the annual aging of a scheme. Often these younger lives are new entrants to the employment market who consider medical aid membership an unaffordable grudge purchase. Prescribed Minimum Benefits (PMBs), amongst other things, have contributed to making options more expensive and by and large unaffordable to new, lower income entrants to join,” said Hannes Boshoff, head of product development at Momentum Health.
Tips to save on your medical costs
In light of these increases, the medical aids provided Justmoney with some tips to help members save money on their medical expenses.

Prevention is better than cure: Discovery, Momentum Health and Liberty Medical Scheme highlighted the need for preventative measures to cut the cost of medical expenses. “Each year, you should plan to go for tests appropriate for your age such as cholesterol, insulin, blood pressure, mammograms or prostate checks, as well as dental and eye check-ups,” noted Liberty Medical Scheme.

Use one plan for the whole family: If you are married, have a life partner or have children, Fedhealth pointed out that it would be cheaper if the entire family were covered by one medical scheme.

Make use of PMBs: PMBs is a list of conditions that medical schemes are required to cover regardless of what medical option you are on. For the full list of PMBs and the 25 chronic conditions that have to be covered by medical schemes, click here.

Use GPs and doctors that your medical scheme has partnered with: Some medical aids have arrangements with doctors or hospital groups, which means that if you visit one of these service providers, your medical aid may cover the entire cost of the consultation. If you choose a practitioner outside of the approved list, the cost may be higher and you may be required to contribute to the cost. “Some doctors and specialists charge more than the medical scheme rate. There are plenty of doctors who have agreed to charge medical scheme rates, so shop around. You’ll find doctors who are part of a medical scheme network, such as Liberty Medical Scheme’s General Practitioner (GP) network, which offer more affordable rates,” revealed Liberty Medical Scheme.

Register your chronic medication: If you have a chronic disease/condition, it is important to inform your medical scheme and fill out all required documentation related to doctor’s visits and any medication you might need to treat the condition. Your doctor will need to fill out the relevant paperwork (for which you may be charged a fee), but your medication will be paid for by the medical aid and it won’t come from your savings.

Know the rates your providers charge: “Become aware of the rates doctors charge, and negotiate appropriately with them to ensure that their fees are in accordance with what your plan options pay,” pointed out Momentum.

Generic versus ethical medication: By opting for generic medications over ethical drugs (the originals) you can save money, according to Momentum.

Be wise when using your medical savings: “For common illnesses, such as flu, your doctor may prescribe over the counter medicines as well as antibiotics to treat your symptoms. When you’re sick, it’s tempting to pay for all your medication on the script from your savings account. But pharmacies charge a dispensing fee for providing medicine on scripts – even for over-the-counter medicines. This means you could end up paying much more than you would if you bought the medicine off the shelf and paid cash for it, helping your medical savings last longer,” revealed Liberty Medical Scheme.

Know your above threshold limit: Some medical schemes have an above threshold limit. This will kick in when you have reached your threshold level, and no longer have funds for your medical expenses. Your medical savings will be used to cover expenses, and when these are depleted, you will be required to pay for any medical costs out of your own pocket (the self-payment gap) until the threshold is reached and the above threshold limit kicks in. “Remember to submit each claim, even if your savings account has run out, as the amounts from qualifying claims still accumulate to the threshold level and you can then qualify for above- threshold benefits subject to further limits,” said Liberty Medical Scheme.

Choose the best option for you: Fedhealth highlighted the need to select the best option to suit you and your needs. You may not require the same cover as a young family or an older individual with health concerns when you are 20, it is therefore important to do your research and choose the medical scheme option that best caters to your needs.

Don’t judge on cost alone: “Even if one option may seem cheaper than another in terms of monthly contributions, there are many benefits that a comprehensive plan offers that you may not get with a hospital plan. This can include things like a medical aid savings plan, or getting a more comprehensive cover for a wider range of illnesses,” noted Fedhealth.

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