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Medical Aid

Unless you are extremely fortunate and can pay medical expenses yourself, you need to consider medical cover. You need to make sure that any emergency treatment, hospitalisation and high out-of-hospital costs can be paid for.

After all, medical care is something we will all need at some time. The type of plan for you, best depends upon what you can afford to pay.

Medical aid is like car insurance-you need insurance for major medical costs–PRIVATE HOSPITALISATION, not necessarily the minor costs-like day-to-day costs.

It is equally as important to know what you are NOT covered for!

Major Medical Expenses. Your greatest financial threat lies with private hospitalisation.

Unexpected trauma or elective surgery can cost a fortune. You don’t know when it may happen or how much it will cost.

  • Do you want private or medical aid rate cover in hospital? Medical aid rate cover costs less, but will only pay around 70% of your private hospital costs.
  • Will you accept an overall limit on hospital cover? Again, it costs less, but remember that if your family are hospitalised together, you could be in serious financial trouble?
  • Would you be happy being treated only by a network of the schemes hospitals.

Day-to-day costs.

Most “New Generation” medical aids have a savings account, from which out of hospital expenses are paid. Thes cheme will “credit” you your total monthly savings up front in your account. Whatever is left at the end of the year, rolls over to the next year.

Some schemes offer threshold benefits, where if your savings are used up and your claims have accumulated to a defined amount-the scheme will pay further claims for that year.

Other schemes pay limited claims from a pool of all member funds. You can still buy a “traditional medical aid”- where everything is covered – from a few companies.

Chronic Medicines.

By law, schemes have to pay medication for 25 conditions (Prescribed Minimum Benefits). However, they can still control the type of medicine and only pay the medicines that fall within their lists (Formulary).

Medicines for other conditions may be convered by the scheme or paid from your savings.

You can elect to only have hospital cover with the minimum cronic medication. Then you are responsible for out of hospital costs.

This type of plan is recommended where you may not be able to afford a full medical aid.

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