Like retirement savings and disability cover, medical cover is a crucial part of everyone’s financial planning. “Good healthcare can be expensive and medical procedures can easily set you back by tens of thousands of rands,” says Sharon Rubens, Managing Director of Completemed Healthcare Consultants, a division of Sanlam Healthcare Management. “Add to that our alarming accident rate and increasing levels of chronic disease, then medical cover becomes an absolute necessity.”

With many open schemes in South Africa, you want to make sure that you deal with a reputable service provider that has a good track record, is solvent and covers a wide variety of conditions and procedures. Do not be shy to do your homework and check on the scheme’s payment and claims history and annual average increases. Reputable schemes will have proper annual statements and good financial record-keeping that reflects the state of their finances and you can call medical institutions or healthcare consultants to enquire if they have experienced any trouble with payments from the scheme in the past. ”

As an employer, you also want to make sure that your employees have access to options that address all their needs, preferably at an affordable price. Although affordability is important, cheapest isn’t always best advice. “They should be basing their decisions on the mix of benefits which best suits their needs,” says Sharon.

When choosing a medical scheme, your employees should consider their individual circumstances carefully. Do they have minor dependents? How often do they visit the GP? Would they be comfortable paying for doctor’s consultations and medication from their own pocket or do they need a savings account to cover it. Do they or their dependents have conditions that require chronic medication or treatment? Does the scheme offer a comprehensive optical benefit should they or their children require spectacles? Does it offer a good dental plan?

Does the scheme pay 100% of the in-hospital charges, or will they have to cover a portion? “Schemes differentiate between actual tariffs charged by the medical institution and scheme tariffs (the maximum rate the scheme pays for the procedure, service or medication). If the scheme tariff is less than the actual amount charged, the member will be responsible for the shortfall or it will be deducted from the savings account where applicable. Knowing exactly how much the scheme pays for what can therefore prevent nasty surprises later.”

“Lastly, your employees should check exclusions and limits. Some schemes exclude claims on certain conditions for a limited period of time when you join, or require medical screening beforehand that may lead to permanent exclusions of a pre-existing condition. They may also limit claims on the day-to-day benefits if a member is new to the scheme, or has never belonged to a medical scheme before. “Make certain employees understand the above aspects, exclusions and limits before they finally settle on a choice,” says Sharon.

For added peace of mind, you or your employees should enlist the assistance of a professional who can ensure that they understand and consider that the benefits offered by the scheme match their individual needs. “Talk to a healthcare adviser who can guide you through all the above mentioned pitfalls and terminology, this will give employees more peace of mind.

If you need free advice when implementing healthcare policies or decisions, contact Completemed and we will assist in making the process a whole lot easier. Our purpose and passion is to assist Employer Groups in providing on-going healthcare advice to enable continuous enhancement of their employees’ wellness and well-being.

All our clients are provided with quality support and assistance in their dealings with various open schemes and medical insurance providers in South Africa.

Completemed contact details:

Direct client care line: 0860 122 340
E-mail address: info@completemed.co.za
Physical address: 2 Strand Street, Bellville, 7530.
Web: www.completemed.co.za