Medical Aid – What’s Not Covered? Do you know all the details of your Medical aid? Do you know where you may be vulnerable? It’s knowing what is not covered by your Medical Aid that may save your health and also your finances, so it is very wise to make sure you know all the details of your Medical Aid coverage today. If you want help with this speak to one of our Medical Aid Consultants today and know the risks you face. As healthcare costs in South Africa continue to rise, an increasing number of people, including the younger, healthier ones, are finally getting the message that enrolling in a good medical aid plan is something of a must. So, they are taking the time to shop around and find a plan that seems to fit their needs and, in some cases, even making some financial changes to fit a more comprehensive medical aid plan into their budget.
What some people do not realise however is that no medical aid plan covers every possible medical expense and that in some cases the plan they had thought was comprehensive enough to meet most of their needs falls a little short.
Medical Aid – What’s Not Covered?
When Good is Not Good Enough, A Real-Life Case Study
Meet Junior and Amahle. As 33-year-old professionals living in Johannesburg, they were among those younger, healthier people who recognised the value of a comprehensive medical aid plan, especially as they were planning to start a family. Having heard some rather eye-opening tales from their less prepared friends, Amahle and Junior decided to opt for what seemed to be an excellent and very comprehensive medical plan, with the assumption that not only would Amahle and Baby get better care but having a child would be easier on their bank accounts than it had been for their friends.
However, when medical bills began arriving, including partial expense charges from the anaesthetist, gynaecologist and paediatrician, as well as the hospital itself, the couple were less impressed. What they discovered at this point was that the medical aid plan covering Amahle only paid out at 200% of the National Health Rates while the medical specialists that she used charged 300% of these rates. This meant that the new parents not only had to pay for diapers and baby clothes and cute nursery stuff, but they also had to cover R10 000 in medical fees they had not expected.
Medical Aid – What’s Not Covered?
Understanding What’s Covered, and What’s Not
Needless to say, Junior and Amahle made some calls to their medical aid provider to make sure that, going forward, they knew exactly what their medical coverages really were, especially now that a baby was in the picture as well. And if you haven’t done so lately, give us a call and let one of our Professional Medical Aid Consultants help you discover the vulnerabilities in your Medical Aid Plan now.
They should be able to tell you which procedures and treatments are covered and how much your specific medical aid plan pays for each of them. To get the best answers though it may be very helpful if you ask them about the following specifics:
- How much emergency cover you have and what is the procedure for making sure that as many expenses are covered as possible?
- In terms of general hospitalisation is there a preferred network hospital you could make use of to get more extensive coverage? cover (do they have a preferred hospital network that they cover in full etc.) Ask the same in regards to outpatient medical specialist visits as well.
- What medical screenings, tests and vaccinations are covered?
- What, if any, medications, outside the mandatory PMB meds, are covered by your current plan?
- What durable medical goods are covered under your current plan?
- Do you have coverage for treatment in the aftermath of trauma? For example, would visits to a professional counsellor be covered?
- Would you have any coverage if you were to travel abroad and become sick or get injured?
Based on the answers you may find that a little extra cover is called for, either in the form of a plan upgrade or gap cover policy. But you won’t know unless you ask, so make that call today and find out the answer to your Medical Aid – What’s Not Covered?