• Hayley Cornelissen

Why you need to understand your Medical Aid Plan

Being diagnosed with a disease or chronic illness can be stressful and traumatic, but having a thorough understanding of what your medical aid plan covers, can help you cope with the news.

Hayley Cornelissen, Senior Consultant at Alexander Forbes Health, says having a good understanding of what you’re covered for and making sure that you and your family are on the right plan for your needs is crucial. Alexander Forbes Health delivers healthcare consulting advice and member support services to over 600 corporate clients.

Being upfront with pre-existing conditions is also vital, to avoid rejection of claims at a later stage. This could mean there is a waiting period before your cover takes effect, during which time you will have to pay your own bills. “Not being upfront about your pre-existing conditions could result in your medical scheme denying benefits or terminating your cover due to non-disclosure,” Cornelissen said.

Changes to your health status could mean your existing plan is no longer suitable for your needs. “Risk tends to increase with age, so your medical aid should be adjusted as you move through the stages of life. Chronic medication needs could change, even though all medical aids make provision for 27 chronic conditions, not all plans provide the same medication cover. If you’re planning on undergoing a procedure or operation, do you know if there are sub-limits, co-payments or deductibles on your plan? Do you know the rate at which your plan will reimburse your providers? You might even be over-insured. In this case, you could save money by lowering your level of cover without necessarily compromising major risk benefits. It’s possible that you have both healthy and sick dependents in your family with different needs. By conducting a proper needs analyst, your medical aid healthcare consultant can guide you to a better solution.”

Most medical schemes have options with GP and hospital networks and regularly change these network listings. “If you’re not aware of this, it could mean that you have to pay a penalty. It’s a good idea to familiarise yourself with your chosen medical aid’s networks and their accessibility.”

Having a good medical aid healthcare consultant is crucial, especially in times when a member has a dispute with their scheme and they can go out to bat for you.

“As with any document that you sign, read the small print and if you’re unsure about anything, consult with your healthcare consultant,” concludes Cornelissen.


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