Taking charge of your medical expenses has become increasingly important as healthcare costs continue to rise. Finding the right healthcare cover, that is affordable and meets your healthcare needs, is the first step. Then it’s a case of making sure you know how to make the most of the benefits and savings available.
Lee Callakoppen, Principal Officer of Bonitas Medical Fund, provides some insights into how you can save on healthcare costs by using networks, Designated Service Providers (DSPs), opting for virtual care and generics to stretch your benefits.
‘Last year we introduced the Benefit Booster that stretches value and equates to an increase in day-to-day benefits ranging from 16% to 100%, depending on the plan,’ explains Callakoppen. ‘This covers all out-of-hospital claims including acute medicine, GP consultations and non-surgical procedures. It is a way for members to unlock additional value and make the most of their medical aid.’
1. Using networks
One way of reducing monthly medical aid contributions, without compromising on care, is to use a network plan. Generally, these are around 15% cheaper however, you must agree to use network hospitals.
‘Networks mean that favourable tariffs for members have been negotiated to avoid out-of-pocket expenses and get more value,’ explains Callakoppen. ‘Using networks also means you can reduce or eliminate co-payments.’
If you choose to go with a network plan, ensure there are doctors and facilities in your area. Check what co-payment might have to be paid for not using a DSP or network. Don’t forget that network options are waived for emergencies.
Medical practitioners and hospitals often charge more than medical aid rates, this means that at times there is a shortfall. A co-payment refers to the outstanding portion of the account, for which you will be responsible.
3. Tariffs and rates of payment
Every medical scheme has a rate of payment called the Scheme Rate. It is the amount the scheme will pay for specific treatments and procedures. The rates are usually higher than the Reference Price List (or RPL) determined by the Department of Health but that’s the departure point from which medical schemes determine their Scheme Rate.
Members often misunderstand that 100% of the scheme tariff/scheme rate doesn’t necessarily means 100% of the account or what is being charged. Make sure you get a quote from you practitioner and/or hospital before any procedure.
4. Virtual has the edge
Technology is driving innovation. The introduction of virtual integration and digital interventions has brought about a different, more efficient way to access healthcare, without compromising on quality. It enables enhanced benefits, stretches benefits while keeping monthly contributions as low as reasonably possible.
5. Designated Service Providers (DSPs)
Healthcare costs in South Africa are generally unregulated, this means providers are free to charge any tariff. However, by using DSPs you can limit out-of-pocket expenses and co-payment and stretch your annual benefits.
‘The Bonitas network includes over 4 000 GP practices, a pharmacy network of around 2 500 to dispense chronic, acute and over-the-counter medicine, 3 000 dental practices and an optical network of over 2 300 practices.’
6. Use generics
A generic is the exact copy of brand-name drugs. They have the same dosage, intended use, effects, side effects, route of administration, risks, safety and strength as the original. But are much cheaper than the originals – on average between 30 and 80% less.
The Medicines Control Council (MCC) carries the responsibility of making sure that generic drugs are safe and effective. Using generics will not compromise on your healthcare but will save you money.
The benefits you receive vary depending on the plan you choose, make sure you read the fine print to understand what is and isn’t covered.
8. Medical savings
A medical scheme allocates an annual fixed amount for medical savings – you need to know what this allocation is and whether you feel it will be adequate for your needs and if you are able to tap into your savings for various of medical expenses.
9. Managed Care
Non-communicable or lifestyle diseases, such as diabetes, high blood pressure and cancer are on the rise. ‘80% of these conditions are caused by lifestyle risk factors,’ explains Callakoppen, ‘which is why Managed Care programmes, aimed at assisting members understand and manage chronic conditions include cancer, diabetes, HIV/AIDS, mental health and back and neck pain are important.’
Make sure you take advantage of these Managed Care initiatives as well as any supplementary benefits offered by your medical aid to save on significant day-to-day expenses such as: Blood pressure medication, cholesterol, blood sugar and Body Mass Index (BMI) measurements through to mammograms, pap smears and prostate testing.
10. Gap Cover
Gap Cover is an insurance policy, designed to cover the difference or part of the difference between what the medical scheme pays and the service provider charges for in-hospital procedures/treatment and specified outpatient procedures, which are subject to limits and exclusions depending on the GAP cover you purchase.
Learn to ‘work smart’ with your medical aid benefits. And wisely. Not only will you have access to quality healthcare but you will be able to save on medical expenses and extend your benefits.