The devastating impact of COVID-19 has underscored that medical aid membership is not an optional “nice to have”. The slow pace towards the finalisation and implementation of the proposed government’s National Health Insurance (NHI) means that for the foreseeable future, individual South Africans will continue having to make important decisions and choices about medical aid cover to access quality healthcare.

Understanding all the options

While there is a vast array of options, medical scheme plans can be confusing. Different schemes offer a wide range of packages, which makes it important for each individual to understand the implications of their choices, depending on personal circumstances. Medical emergencies can arise at any time, and it is not always possible to be prepared emotionally and most importantly, financially. State institutions are often not resourced adequately, hence the need for medical aid cover to meet the costs of medicine, treatments, and hospitalisation.

The importance of making an informed choice when deciding on medical aid membership cannot be over-emphasised. Cost is always a factor, but ultimately there is no price too high to pay for the best healthcare when the need arises. An important principle is to understand your needs in order to choose the option. It is often recommended to become a medical aid member at a younger age before the onset of many medical conditions that develop as we grow older. A person in his early twenties without chronic illnesses is not likely to need comprehensive cover but should have access to quality healthcare for emergencies.

Hospital plan vs full cover

That is why it is important for one to be advised appropriately regarding the implications of opting for a hospital plan against full cover, for instance. Different circumstances suit people differently, and every effort should be made to understand the full extent of benefits to avoid misunderstanding. How often have we heard of disputes when members discovered that their medical aid options did not provide for them to undergo certain life-changing surgical procedures? There is also sometimes confusion about annual hospital limits and how one can best utilise savings funds where they are on offer.

Best medical aid cover should also make provision for a measure of flexibility as a member’s circumstances change. For instance, their marital status and the birth of children need to be accommodated as well. Some schemes offer better packages than others for families and spouses.

Seek advice

As is the nature of any industry, there is great rivalry and competition among medical aid schemes. Therefore, it is often recommended to obtain independent advice from an adviser. They are best placed to conduct a full needs analysis and make suggestions on the most appropriate options.

Much of the information about the performance of medical aid schemes are freely available. One can often get a sense of the members’ levels of satisfaction or frustration by doing an online search.

The industry is regulated under South African laws, but that does not guarantee that all medical aid schemes provide optimal service and the best value for members’ monthly contributions.

COVID-19 an eye-opener

COVID-19 has also given fresh impetus for us all to take better care of our health. The restrictions on movement and the new phenomenon of working from home have inevitably contributed to much more sedentary lifestyles. Health professionals have for many decades warned us of increased lifestyle disorders arising from a lack of adequate exercise. Younger people are developing medical conditions that were previously associated with advanced age, for instance, heart and lung ailments.

This also serves to highlight the importance of understanding one’s own health circumstances. It’s vital to invest wisely in a medical scheme that will address specific needs and circumstances in a world coming to terms with the challenges of the pandemic. – Health-e News