What is a medical scheme?

A medical scheme helps you to pay for your healthcare needs, such as nursing, surgery, dental work, medicine and hospital costs. It can be described as “insurance” you are taking out to cover your health costs. You (and in certain cases your employer) pay regular contributions to the scheme. A medical scheme is a non-profit organisation and should be registered at the Registrar of Medical Schemes. A board of trustees who are elected by the schemes’ members manages a medical scheme. They are responsible to manage the scheme to the benefit of its members.

Why should I have a medical scheme?

There are many advantages belonging to a medical scheme.

·                         You have the security of knowing your medical needs will be looked after

·                         A portion of your contribution can be deducted from your taxable income

·                         You can budget for your medical expenses

·                         You can get the best medical care available

·                         You can undergo medical surgery when you need it most

·                         You will be treated immediately in the case of an emergency

·                         You can benefit on a personal level with different wellness and vitality options available

Manage Your cover responsibly

To experience the true value of a medical scheme requires some forward planning.  Doing your homework on the scheme’s policy on payment of claims and general cover can save you time and money."

Overlooked issues: easily avoided

Assuming you’ve realised the benefit of medical cover and have found an option that works for you, don’t make the mistake of forgetting all about your healthcare partner until you need a claim paid.

There are some common problem areas which members frequently experience, all of which can be attributed to lack of knowledge on the part of the member. These issues can be easily avoided and include the following:

The three month rule: Most schemes require the member to submit any claims for payment within three months. It is the member’s responsibility to ensure this deadline is met. Failure to do so will result in the claim becoming stale and the scheme will not cover the costs. A simple rule to remember, but one which unfortunately catches many people.

Pharmacy fees: Most pharmacies charge an admin fee when submitting a medication invoice to your medical scheme for payment. Most schemes do not cover this fee. You can avoid this fee if you pay cash instead for your prescription and submit the invoice to your scheme yourself.

The rate debate: A medical scheme pays claims at the rate stipulated by that scheme. The scheme member is liable for the shortfall resulting from medical practices charging rates higher than the scheme covers. Some medical schemes will pay for costs originating from above scheme rates however this is at an additional cost to the member. Ask your broker about options that bridge this gap – you may pay marginally more in your premium each month, but you’ll be covered for considerably more.

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