Medical aid: What are your choices?
How does one choose a medical scheme? Is a hospital plan sufficient? Should I perhaps take out medical insurance? These are some of the questions being placed under the spotlight this week
WITH ever-increasing membership fees it’s really pertinent to investigate the various options of medical expense coverage and choose the option which best suits your pocket. It’s fabulous if you can afford a fully comprehensive medical aid which covers every aspect of your health needs, but we need to face the fact that the majority of South Africans often don’t have access to that kind of funding.
Hospital plan versus medical aid
If you need the most basic cover, then a hospital plan is the best starting point as it caters for your in-hospital procedures and usually, your annual check-ups.
The hospital plan is ideal if you are young, healthy and only need cover for yourself or merely looking for cover in case of an accident or an emergency procedure.
You must, however, bear in mind that a hospital plan doesn’t provide day-to-day medical cover, only treatment and consultations while hospitalised.
If you cannot afford a full medical aid plan then this is definitely a good option.
Insured health benefits
Health insurance works in the same way as any other insurance cover, however, you often have to pay your hospital costs up front and then claim back your expenses.
This, once again, depends upon the level and type of cover you have chosen as the insurer may pay or negotiate with the practitioner or hospital directly.
National Health Insurance
In December last year, the Department of Health released a White Paper entitled ‘National Health Insurance for South Africa – Towards Universal Health Coverage’ (Version 40) in which it investigates the costs and quality of health care services.
‘Even they are usually denied access to health care before the year ends because they are supposed to have run out of benefits.’
By introducing a National scheme such as National Health Insurance (NHI), the Department believes that all South Africans, irrespective of their socio-economic status will be able to receive affordable, quality health care services.
The idea is to introduce NHI in three phases over the next 14 years and to this end the Office of Health Standards Compliance (OHSC) has been established to oversee and shake up the quality of health care currently being provided by governmentfunded providers both at primary health care and at hospital levels.
Just after WWII, Britain introduced its National Health Service (NHS) and although it still has many flaws and extremely long waiting lists for certain surgical procedures, the service was offered in the belief that all should have access to the same level of quality medical care.
The bottom line, however, is that we all need some kind of financial protection with respect to receiving the best treatment and that no-one should be turned away from a hospital because of their socio-economic status.
We are fortunate that we have plenty of ways to cover out medical expenses, so it’s up to you to investigate, compare and find the best solution to suit your needs (and your pocket).
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