Medical Aid Costs Associated with Various Plans

    February 27, 2016

    Medical aid members dread the start of a new year because this is when the medical aid costs rise as shemes release their price increases for the year. The whole idea of a medical aid is to ensure that you are able to pay for treatment received from a doctor or while in hospital. Medical schemes such as Discovery, Fedhealth, Bonitas and Momentum are included and increases are between 8 to 10.5%.

    When choosing medical aid cover, a comprehensive plan can offer many benefits relating to medical aid costs that you may not get with a hospital plan. Some medical schemes however, offer hospital plans that are pretty basic with an associated low medical aid cost while other hospital plans are so comprehensive, they are becoming a first choice for many South Africans.

    Medical Aid CostsWhen you look at medical aid costs for a member, spouse and two children, you want to be sure of the rates you’ll pay while in hospital and the benefits. Each medical aid offers different plans and different costs, from hospital plans to fully comprehensive plans to network plans and savings plans.

    Huge Difference in Medical Aid Costs

    • Discovery Plans are varied but its KeyCare Core, Access and Plus plans have the most affordable hospital plan rates. The plans provide private hospital cover, guaranteed full cover in hospital for specialists on a payment arrangement, and up to 200% of their Health Rate for other healthcare professionals. They also cover medicines for all ongoing illnesses.
    • Their Coastal Core Saver, for R2273,00 gives outside-of-hospital benefits through a savings account which is a good choice for who want a self-managed savings account. Their top range hospital plan is their Executive plan at R6008,00 pm for 300% medical aid rate in hospital is expensive but it happens to be comprehensive. You get hospital benefits in the private sector, specified specialist benefits with arranged payment and full benefits for many chronic conditions.
    • Similar to Discovery and the Fedhealth hospital plan, the Bon Essential plan offers in-hospital cover in any private hospital in South Africa. Other benefits include unlimited overall annual limit among others. This plan is pretty comprehensive as far as hospital cover goes while their BonCap is a network plan for those with an income below R14 500. You get limited hospital cover along with additional day-to-day cover at a GP within the scheme’s network. It’s a good option if you’re on a tight budget.

    Do You Understand Co-Payments?

    A hospital plan pays up to a specified amount for the treatment you get in hospital, while hospital cash-back plans will pay for the days you spend in hospital. If a scheme says it will pay up to 100% of the medical aid rate, that could be lower than your actual hospital bill and you could face a co-payment.

    It is important with the various plans to check what percentage of the medical aid rate the individual hospital plans will cover. Some plans require you to use network hospitals or designated service providers (DSPs) and you’ll be looking at huge co-payments if you don’t use these designated service providers. The hospital plans which come with a day-to-day savings portion for out-of-hospital expenses are more expensive.

    A Solution to Medical Expenses Beyond the Scheme Payout

    A hospital plan provides financial protection in terms of medical bills but because of the different plans and costs medical gap cover is a necessary evil if you don’t want to pay for the exorbitant medical expenses which are above the scheme payout.

    Tariffs for medical treatments and services are paid in keeping with the National Health Reference Price List, but there are many doctors who charge well above the NHRPL rate. Gap cover is seen as an essential policy for this reason, and without it you would have to reimburse the doctor out of your own pocket.

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    All info was correct at time of publishing