Choosing a medical aid plan is considered to be one of the most complex decisions you will make. Every medical aid plan has different limits and exclusions, and the more basic the plan the more limited your options are. It is therefore essential to understand the terms and conditions of the option you choose.
Here are 4 steps to help you optimize your benefit from your medical aid scheme.
- If you need to undergo a medical procedure, ask you medical scheme to provide you with a list of Designated Service Providers (DSP’s) for the procedure and other medical products that you require. These providers usually have agreements with the medical schemes for non-prescribed minimum benefits as well.
- Request the codes that will be charged by the surgeon (DSP). This will include the procedure codes and codes for any other medical products that are required.
- Discuss the medical scheme tariffwith your surgeon and negotiate the price that you will pay.
- Determine if there is likely to be a shortfall, and if there is, speak to your broker to advise you on a suitable Gap Cover to provide cover for these shortfalls.
Do you know your PMB’s?
Prescribed Minimum Benefits (PMB’s) are a set of defined benefits that ensure all medical scheme members have access to certain minimum health services. This means that on any plan you choose, your PMB’s will be covered.
PMB’s are prescribed in the Medical Schemes Act, which stipulates that all medical schemes have to cover the costs related to the diagnosis, treatment and care of:
- Any emergency medical condition
- A list of 270 medical conditions (defined in the Diagnosis Treatment Pairs)
- And 25 chronic conditions (Chronic Disease List)
Ensure your chronic illnesses are registered to ensure that the treatment thereof is paid from your risk benefit and not from your medical savings account.
– By Sharon Rix
Verso Health (Pty) Ltd is an authorised Financial Services Provider with license number 45466 and is accredited by the Council for Medical Schemes with the number ORG4196. To find out more on what Verso Health offers click here.
This article is a general information sheet and should not be used or relied on as professional advice. No liability can be accepted for any errors or omissions nor for any loss or damage arising from reliance upon any information herein. Always contact your financial adviser for specific and detailed advice. Errors and omissions excepted. (E&OE)