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Finding the Right Medical Aid in South Africa

For those that feel that medical aid costs too much but is a necessity, did you know you can tailor medical insurance to suit your budget?

How to Tailor Your Medical Insurance to Suit Your Budget

1. Consider the Fund’s Reliability and History

Always select a recognised fund with a long-standing reputation. This ensures you get the best service possible and that you will be paid promptly when claiming.

2. Consider The Coverage and Type of Plan

If you have children or dependants, enquire whether the fund will provide for all their needs. Medical aid cover varies greatly, and their needs may not all be covered. Some plans, such as a hospital pans, are usually for hospital stays only, whereas medical aid cover could cover anything from doctors’ visits to medication, dentistry, and eye care. Your cover depends on the plan you choose.

Hospital plans differ from each other, too. It is important to understand how they work. Some cover only your expenses during your hospital stay, whereas others will also offer certain savings benefits that will cover your daily out-of-hospital medical expenses like your medication and some or all your doctor’s visits.

Some hospital plans only offer network plans which are more affordable but could prove to be inconvenient as you will only be able to make use of the prescribed service providers, which includes hospitals and doctors – a rather restrictive option. Remember that on your medical aid you might have to pay an excess for procedures such as scans, gastroscopies, and extractions of wisdom teeth.

Hospital costs are not always covered in full, and if the doctor’s fee is more than the medical aid rate, you will have to cough up and pay the difference. South African aw allows insurance providers to determine the rate they are wiling to pay for each medical professional, an amount that is often much lower than the professional’s actual fees. It’s important to consider these minimum rates before you choose your medical aid.

3. Consider Waiting Periods

Take note that if you decide to change funds, you will often need to wait out a three-month period before you can submit any claims.

4. Consider Upgrades & Downgrades

Similarly, if you need to upgrade or downgrade your medical aid plan during the year, bear in mind that there are only a handful of medical aid funds that permit their members to do so. Otherwise, you will need to wait a year to make these changes.

When you understand exactly what each provider and pan offers, choosing the best one for your needs and budget is much easier. The most affordable option isn’t always best because cover is so vastly different between plan types. Comprehensive plans provide the widest coverage, whereas network and hospital plans may be cheaper and much more limited.

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