As begrudging as it is to have medical aid deducted from your monthly salary, it is an imperative aspect of your daily life and wellness needs. Medical cover may take a sizeable chunk out of your income every month; therefore the question is how do you then make sure that the cover you choose is the right one for you?
Written By: Zimasa Qolohle Mabuse
When shopping around for medical cover or choosing what plan you will fall under the said cover, a number of factors are important to note:
Check the finances
Conduct a critical assessment of your monthly salary and how far it stretches, then proceed to question what your net salary is after your other main deductions. A great indicator would be to spend around 5% – 6% of your monthly gross salary on medical cover. This percentage spend is not only affordable, but will also allow you to have adequate coverage and value for your money. When you decide to join a medical aid scheme, further check which provider gives you the best deal for your spouse and children, and exactly what your monthly contributions would be.
Check your health
It goes without saying that chronic illnesses such as asthma and diabetes, which require frequent use of special medication, will cost you more on a daily or monthly basis. Be honest with yourself with regards to your health and wellness needs, and rather choose a scheme that will cover the medication you frequently require, to avoid having to pay for said medication out of your own pocket. Conversely, should you be in great health and suffer from no medical conditions, ensure you do not short-change yourself by choosing excessively minimal coverage, as other wellness check-ups do come up that cannot be avoided no matter what the status of your health, such as dental hygiene, optometry etc which can also eat into your hard-earned money if not properly accounted for.
Full cover vs Hospital plan
Decide whether you can afford the normal day-to-day medical expenses, such as GP visits yourself. Hospital plans are often far more affordable than full medical cover, but do remember that even hospital plans cover you for 25 specified chronic conditions (known as PMBs).
Scrutinise the table of benefits
A scheme may look wonderful on paper, as they appear to pay 100% of the cost on a variety of circumstances, but do check what the day-to-day limits are and how much your Medical Savings Account (MSA) is per year. If the MSA is small, you risk exhausting your day-to-day cover by February! Furthermore, take note that many private hospitals do not charge medical scheme rates, which could ultimately leave you with an exorbitant bill after your hospital stay, despite having hospital cover. Therefore, find out what co-payments you will have to make on all bills.
Find out about exclusions
Some schemes may exclude you from claiming for certain conditions for a limited period of time (not more than one year). Be aware of these possible exclusions before signing on the dotted line. Also, if you are not coming straight from another scheme, and this is the first time you join, you can usually not claim for day-to-day expenses in the first three months.
Most importantly, stay healthy!
As scary as all the above information may be, unfortunate medical occurrences can be avoided by maintaining a healthy lifestyle. Avoid the stresses of seeing a doctor and landing up in hospital by exercising at least 5 times a week (remember, exercise can be done almost anywhere, and you don’t necessarily need to spend on hefty gym fees), consuming as many greens a possible (save money by purchasing your fruits and vegetables at produce markets and outdoor vendors as opposed to buying them at the grocery store), drinking as much water as possible (2 – 3 litres a day) and having a general optimistic outlook on life.
Without good health and a well-functioning body, all the wealth and success in the world cannot be truly relished. Look after your health and ensure you are adequately protected in times of illness and exceptional circumstances.
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