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Choosing a medical aid

Small businesses employ between 50 and 60 percent of South Africa’s workforce and contribute around 34 percent to the GDP.  It is one of the country’s biggest development opportunities which is why having a healthy SME workforce is critically important. Any prolonged absence from work of important staff members due to illness or injury, can cripple a small business financially.

There is no doubt that the public healthcare system functions poorly and those seeking medical treatment can spend hours waiting at a clinic or hospital.  This means a massive loss of productivity for a small business and can be very costly in terms of survival.

Ensuring that small business owners and their employees join a medical aid will not only provide quality healthcare but reduce time away from work.  It is an important decision to make and one that needs to be weighed up carefully, taking affordability and the benefits of private healthcare into account.

Most medical schemes offer a range of healthcare options – from traditional medical aids through to hospital, savings, network or income based plans – that makes private healthcare more affordable.  However, navigating your way through all the options can be tricky.

Lee Callakoppen, Principal Officer of Bonitas Medical Fund says it is best to ask for advice from a medical aid broker.  It will not cost you anything and, together with the broker, you can work your way through the different options and choose the medical aid plan best suited to your and your family’s needs. The broker will also know the financial stability of the scheme, which is also a consideration in the final decision. .

Alternatively, if you opt not to use a broker, Callakoppen says these are things you need to consider:

Analyse your healthcare needs

No two people or families are alike, medical needs differ. Do a quick personal healthcare needs’ analysis to determine what cover you need.  If you have dependants, factor in their healthcare needs too. You need to consider the following:

  • How often you and your family visit a doctor or specialist
  • Over-the-counter medication or chronic medication required
  • Chronic conditions like high blood pressure or diabetes
  • Specific conditions like cancer, HIV/AIDS or renal failure
  • How much do you spend on dentistry or optometry

Then consider which of the expenses were once-off and won’t come up again soon (like childbirth) and which are likely to come up again and again (such as flu).  This will help you decide on whether you need a comprehensive medical aid or a hospital plan.

Read the small print

Take the time to read the information sent to you by the scheme and/or your broker. Benefits vary from plan to plan, so establish what is and isn’t covered.

Ask what supplementary benefits might be available to you that can potentially save significant day-to-day expenses. These could include preventative care benefits, ranging from basic screenings (blood pressure, cholesterol, blood sugar and Body Mass Index (BMI) measurements) through to mammograms, pap smears and prostate testing. In some cases, this extends to maternity programs, dental check-ups, flu vaccinations and more.

Once you understand what is on offer, you can make an informed comparison and decision.

Managed Care options

Managed Care programmes help members manage severe chronic conditions such as cancer, diabetes and HIV/AIDS.

What about savings?

Medical savings are a fixed amount a medical scheme gives you at the beginning of the year.  There are ways to maximise your savings but first you need to know what your annual allocation is.

The day-to-day detail

Look at what the scheme suggests as ways to make your benefits last, bearing in mind the following:

  • Some plans require you to use a specific GP, hospital network and have a list of Designated Service Providers (DSPs). These keep costs down because the scheme will have negotiated special rates with these services providers. Check the network in your area before making a final decision
  • Must you be referred to a specialist by your GP?
  • Does your medical aid offer additional GP consultations, which they will pay for, after you have exhausted your day-to-day benefits?

Virtual Care and technology

Technology and virtual care are being embraced by medical schemes and members. Check what is offered on the plan you’re considering and whether you’re able to access your benefits and medical information 24/7.

Age impacts your decision

As parents of young children, ensure that the medical aid option you select provides sufficient child illness benefits. For young couples looking to start a family, check that your option provides sufficient cover for maternity benefits.

However, if you are slightly older, then ensure that the option you select covers chronic conditions and provides sufficient in-hospital cover in the event of hospitalisation.

Ensure the affordability

Consider all the costs involved before you make your final decision, such as:

  • Monthly contributions: The rule of thumb is that contributions should not exceed 10% of your monthly income at an individual or household level
  • The cost of co-payments for various benefits claimed. A medical aid co-payment is a fee that the member is liable for when making use of certain medical services
  • These co-payments usually apply to specialist or elective medical procedures. This differs from one medical aid scheme to another. It is one of the reasons why you should always do thorough research, before deciding which medical aid scheme is the best option for you. The ideal option would of course be the one that does not require any or very little co-payments from the member.

Waiting period and exclusions

The Medical Schemes Act and the specific scheme’s rules determine this.  Bonitas recommends that you enquire with the relevant scheme about their exclusion list and waiting periods. 

Remember: Health is your wealth, which means it impacts you and your employees. Financial wellbeing goes hand-in-hand with physical and mental wellbeing.  A healthy workforce is a productive one which is why there has been a distinct shift towards making wellness a serious focus to address work-life balance and maintain good health.

Bonitas Medical Fund is a proud Partner of the NSBC

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