It’s no wonder the public is so confused about health care cover!

    March 6, 2017

    When it comes to health care cover, it is no wonder the South African public is so confused.

    They have several choices:

    More often than not choice is dictated by the price they have to pay.

    Comprehensive Medical Aid costs a fortune, and the terminology is misleading.


    The question should be “comprehensive cover for what”?

    Policyholders needing to undergo in-hospital surgery are told they are covered for 100% of the costs.

    That is a misleading statement.

    They only cover 100% of the Medical Scheme Tariffs (MST) which is far less than what experts charge.

    Health Care CoverSo what should they do?

    Brokers tell them to get gap cover.

    Gap cover pays the difference between the medical scheme’s “100%” and final accounts submitted by medical professionals for services rendered.

    But Gap cover costs money.

    Gap cover is a great option. But members cannot always pay even more money on top of the R4500+ monthly fee for health schemes.

    So what about a Hospital Plan?

    Well, here again, they get what they pay for.

    The cheaper the plan, the fewer benefits they will receive.

    Hospital Plans offered by medical schemes all differ, depending on the type of cover requested.

    For example, cheap Hospital Plans dictate which network of service providers the client must use – that includes doctors, specialists, hospitals and ambulances.

    In fact, some cheap Hospital Plans only cover clients for medical procedures undertaken in State hospitals!

    So what’s the point when setting aside a chunk of one’s monthly budget leaves members in exactly the situation they want to avoid – medical treatment in a State hospital!

    Read the fine print

    Most times the difference between cheaper plans and those offering treatment in private hospitals are well worth the additional costs.

    Points to remember about health care cover

    Use emergency transportation dictated by the medical scheme.

    Policyholders should always adhere to the terms and conditions of their contracts.

    Use hospitals designated by the medical scheme.

    Use medical practitioners contracted to the medical scheme.

    Further, brokers suggest hospital plans for people who are younger and healthier.

    By following these “rules” policy holders will derive the full range of benefits of their Hospital Plans and avoid extra costs.


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    All info was correct at time of publishing