Beware of Medical Payout
It is alarming to learn just how many people
are not fully aware of the terms and conditions that apply to their medical aid plans. There is no plan that offers
unlimited cover, regardless of what the scheme says or promises. All plans feature ceilings and it is vital that
members of medical schemes are aware of these ceilings.
What do they mean by a
Medical schemes place a limit on the amount of money that can be claimed for
medical expenses. When this limit is reached, the member does not enjoy cover any longer. The following points
are salient and should be considered when evaluating medical aid plans:
Many medical schemes say that they offer full in-hospital cover but what they mean is that they will cover
treatment only at the approved medical aid rate. Many hospitals and doctors charge much, much more than this
approved medical aid rate and members that thought that they were fully covered find to their shock that they are
liable for the difference. In cases of hospitalization this difference can be a substantial amount of
Some schemes offer their members medical savings accounts. The member uses the money in this
account to pay for day-to-day medical expenses. However, the amount that is available is limited and
once the account is exhausted the member has to pay for further medical costs. There is more: medical
schemes categorize medical expenses and each category has a separate limit. It is therefore perfectly
possible to have funds available to pay for, say, dentistry but have no funds to pay for a visit to a
Some schemes carry unused funds over to the next year but others do not. It is vital that members
make sure what happens to unused money.
Many schemes require their members to make use of service providers that they have approved. In
most cases the scheme enters into an agreement with these service providers and if members want to use
another professional, they are liable for the cost.
How to protect yourself
against unexpected medical costs
It is of the utmost importance to study the terms and conditions of a medical plan and to keep
careful record of expenditure as the year progresses. If the limits are regularly reached, it may be
necessary to upgrade the cover enjoyed.
It may be useful to purchase additional medical insurance. Some companies offer excellent
cash-back insurance policies that will pay a specified amount for each day spent in hospital. This
money can be used to cover the shortfall.
Communicate with the medical scheme prior to undergoing expensive treatment or before being
admitted to hospital. In this way unpleasant surprises can be avoided.
Be realistic when selecting a medical aid plan. It may be a good idea to ask a doctor to perform
a thorough risk assessment. People with a family history of a specific disease or condition must accept
that they are also at risk and that they must make provision for the treatment of such
Many people have found themselves in a
position where they have to pay a hefty medical bill while they were under the impression that they were covered.
The importance of studying the exact nature of the cover provided by a specific plan simply cannot be
overemphasized. Avoid medical payout ceilings before they happen. © Medical Aid
To get your medical aid plan quote by email Click