Is Your Medical Aid Sufficient Health Cover?
Many people live under the illusion that they are
fully covered for their medical expenses and only find out that they are not when they are faced with massive
bills. Most members of medical schemes cannot rest assured that they will be able
to claim all medical expenses from their schemes: in most cases there will be a self-payment
When will my medical aid not
There are several reasons why members may be
required to pay certain treatment cost themselves. The most important of these are as
- If your medical savings account is exhausted
you become responsible for further expenses.
- Most plans have treatment limits. If you
exceed this limit you will be held liable for further expenses. You need to make sure that you are fully
informed about the limits set in your specific plan.
- Your medical practitioner may charge more
than the rate that will be paid by the medical scheme.
- The scheme may refuse your claim if they are
of the opinion that your condition does not feature on the Minimum Benefits list. There are approximately 300
conditions on this list and it may be wise to check with the medical scheme before undergoing
- You may have exceeded to limit for the
management of certain conditions such as asthma and various cancers.
- You may have decided to opt for treatment
that is specifically excluded by your medical scheme and which is described as “self-payment”. In some cases
the scheme will pay only a portion of the cost. It is always a good idea to check with the scheme before
agreeing to any treatment.
- If you suffer from cancer the chances that
the scheme will meet all the costs are very slim indeed.
- If you require synthetic body parts such as
will be the case with hip replacements, heart transplants or if you use devices such as wheelchairs then you
will have to accept the fact that the scheme will not pay for top-of-the-range
- Very few plans make provision for organ
transplant. If you require a transplant you should check with the scheme
- Patients that require prolonged
rehabilitation often find that there schemes will only cover the cost for a short
What can I do about it?
There are a number of steps that will help to
lessen the shock of unexpected medical expenses:
- Make sure that you study the terms and
conditions of your specific plan very carefully. It may also be wise to choose a plan that can be upgraded when
circumstances demand such a step. If you have questions, ask your medical broker or your scheme to explain the
- Always check with the medical scheme before
visiting a specialist or hospital or before agreeing to treatment and surgical
- Think about increasing the size of your
medical savings account. In this way you can build up an emergency fund that will be extremely helpful when you
are faced with major medical expenses such a cancer treatment or organ transplants, for
- Do not be intimidated if you suffer from any
of the conditions that are on the Limited Benefits list. Your medical scheme has to cover the cost in full. If
a dispute arises you are entitled to approach the Council for Medical Schemes.
- It is against the law to belong to more than
one medical scheme, but nothing stops you from purchasing additional health cover through medical insurance policies. Many
insurance companies also offer gap cover. © Medical Aid Plan