Being diagnosed with a disease or chronic illness can be stressful and traumatic but having a thorough understanding of what your medical aid covers can help you cope with the news.
Having a good understanding of what you’re covered for and making sure that you and your family are on the right medical aid for your needs is crucial.
Being upfront on pre-existing conditions is also vital, to avoid rejection of claims at a later stage. This could mean there is a waiting period before your cover takes effect, during which you will have to pay your own bills. Not being upfront about your pre-existing conditions could result in your medical scheme denying benefits or terminating your membership due to non-disclosure.
As you age, your health risks tend to increase, so your medical aid should be adjusted as you move through the stages of life. All medical aids should make provision for at least 27 chronic conditions but not all medical aid plans offer the same medication cover.
If you’re planning on undergoing a procedure operation, do you know if there are sub limits, co-payments, deductibles on your plan? Do you know the rate at which your plan will reimburse your providers?
Most medical schemes have options with GP and hospital networks and regularly change these network listings. If you are not aware of this, it means that you might have to pay a penalty.
With most medical aids these day’s you have your hospital cover and then a savings.
The hospital cover will pay for your hospitalization if it is needed, with certain limits and sub limits.
The savings account will cover all the out of hospital claims for example, doctors, dentists, blood tests, x-rays etc. If you have run out of savings all those claims will have to be paid out of your own pocket. So, it is very important to take all those possible expenses into consideration when you decide on a medical aid.