Medical aid is especially daunting. When it comes to this, it is not always a good idea to simply go for and agree to a medical aid scheme just because it seems to like it’s got so much to offer. There are so many risks involved that if you do not thoroughly review a medical scheme offered by authoritative bodies; you might just end up as another statistic. Now, the best way to protect yourself is to know and understand your rights as a citizen of South Africa. Know what you are entitled to, your benefits, and everything else that comes with being provided with medical aid.
In general, every South African citizen is entitled to some sort of medical aid based on the circumstances that they are in. These include a couple of medical benefits and even free health care. Hospitals, clinics or public administration bodies usually provide these medical aid schemes. Medical aid schemes usually cover doctor’s bills, treatment procedures and medicines, and some even cover hospitalization expenses. Whether in a public or private hospital, these schemes are recognized depending on its coverage.
First, know the exact coverage. Do some research on the pricing which is compiled through the National Health Reference Price List. The pricing here is used as a reference as to what are the accepted limits when it comes to procedure costs. This is where the medical aid schemes usually base their coverage; the NHRPL would reflect the lowest rate to be covered by the scheme. Private rates or service providers usually charge higher, about at least 300% more. It is therefore essential to know the rate offered by your provider as well as the rate of your compensation.
Essentially, medical schemes offer the same benefits consisting of Prescribed Minimum benefits, Risk benefits and a Savings benefit. Prescribed Minimum Benefits may cover around 65 chronic conditions. If the situation concerns a treatment, which might not be on the formulary covered by the scheme, it may offer an alternative. A twenty-five percent maximum premium from the risk benefit is allotted for the savings benefit, which is actually reserved for out of hospital treatments. Once these savings are used up, they are renewed after a year. When it comes to trauma incidents, unfortunately, not all medical schemes offer coverage for this. The same is true for other diagnostic procedures such as colonoscopy, CT scan and gastroscopy.
When it comes to the rules of a scheme, the member of a registered scheme may list his or her spouse, minor children and any other person who is “recognized as a dependent of the member”. The company may provide the medical scheme you work for, and the coverage may be dependent on the number of dependents that you have and your salary. However, it is important to also note that not all companies offer this benefit; this is why some go for individual memberships instead. If you have your own registered medical scheme and you get married, you may have to choose between you and your spouse’s scheme, as it is illegal to be under more than one medical scheme at once.
There are so many different things that one needs to learn when it comes to understanding your rights with regard to medical aid. The best thing anyone can do is to seek help from authorizing bodies who can better explain the legalities and the other details about medical schemes in order for you to be sure that no provider, health organization or doctor will end up ripping you off.
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