It’s the time of the year when you hit refresh, spring clean and says goodbye to old habits.
Now may also be the perfect time to refresh your knowledge about your insurance, like your medical aid plan, to check that it still meets all your needs. Your medical aid is there to help you when you need it most and there are a few ways they can help you save too. Here’s how:
1. Know your plan. When you understand your plan and ensure it meets your needs, you will know exactly what you can claim and what you may have to pay yourself. Some plans pay claims at the rates in the national reference price lists, while other plans pay a higher rate. When the service provider charges within the rates on your plan, your medical scheme will pay your healthcare provider directly. Read the material from your medical scheme, use their website and speak to your financial adviser about your plan to make sure it’s the right one for you.
2. Know the rates your doctor’s charge. You don’t have to be embarrassed to discuss money with healthcare providers. It’s the same as with any other service or product you buy. Ask about the rates so that you know if you will have a co-payment. That way, you can choose if you want to shop around for a provider who charges at the rates your plan pays or if you’re happy to pay more – knowing beforehand exactly how much it will be. Your medical aid will also be able to tell you about how you are covered on your plan.
3. Tap into networks your medical scheme may have. Most medical schemes have network arrangements in place to help you save. In these networks, your medical scheme pays claims directly to providers based on your plan. Direct payment reduces your paperwork and using a network keeps the cost down. Discovery Health Medical Scheme, for example, offers extensive GP and other networks to make sure claims are paid in full and directly to providers. If you’re uncertain if a provider is part of a network, call your medical aid or visit their website.
4. Know the payment arrangements with specialists. You can benefit here too by not having co-payments or extra admin. As an example, Discovery Health Medical Scheme has direct payment arrangements with the majority of South Africa’s specialists on most of its plans. If you see one of these specialists, you won’t have a co-payment. When a specialist does not have an arrangement with your medical scheme, you may have to pay up-front or pay a portion of the costs yourself – depending on your plan. Know your plan well and use the medical scheme’s website or call them to find out about your options.
5. Avoid co-payments by using pharmacy networks. In an effort to give you full coverage on medicine, your medical scheme has pharmacy networks where you’ll have no co-payment on medicines that are on the scheme’s medicine list. There are now more than 2 500 pharmacies in the network that Discovery Health Medical Scheme members use. It is worth finding these offers to save money on your medicine by having no co-payments.
6. Pay cash for over the counter medicines. Don’t claim for everything from your medical aid. As far as possible, pay cash for over-the-counter headache tablets, cough preparations and other similar types of medicine. Paying cash for these medicines will help to stretch the money in your savings account further so that you have funds for the more serious, more expensive acute treatments you may need.
When you know your plan and how it works, it is possible to save. You have an opportunity to increase your cover at the end of every year, so it’s a good time to look at your health and decide if you need to make changes. Take time to go through your plan, understand the savings you get from using networks and get advice from your financial adviser about the plan that is best for you.
Listen to “Understanding the world of healthcare” as Azania Mosaka examines how medical schemes work, what affects increases, and uncovers many other good-to-know facts. Want to know more about diabetes, heart health, dangerous superbugs or the future of healthcare? Discover Healthier, hosted by Azania Mosaka, has it all. Find the Discovery South Africa podcast channel on your favourite platform and start listening today.
See the medical aid plans offered by Discovery Health Medical Scheme.