Having a company medical aid is a benefit that not all workers are fortunate to have. It is not mandatory but may employers see it as an incentive to employees above and beyond the monthly salary and year end bonus. Some companies pay 33% (one-third) of the monthly contribution while others may be generous enough to fork out as much as 66% (two-thirds) of the premium. It also takes some of the hassle out of the administrative side of things for workers, as medical aid premiums are deducted from the salary and paid by the employer to the medical scheme. But what if you employer does not pay your medical aid premium in full this month, or has missed the payment to the scheme altogether?
Unless it is an emergency situation, you cannot simply walk into a private hospital and request admission even if you are on a medical aid. Many medical aid members are under the misconception that having cover means guaranteed and immediate admission at any private hospital in the country when they want it. The is a specific hospital admission procedure that needs to be followed. But if you are in an emergency situation, the private hospital and medical aid will bypass these procedures to ensure that you get immediate medical care.
Medical aid fraud has become somewhat of a hot topic in recent months after The Times newspaper reported on the seriousness of the matter in the healthcare industry. However, it is not a new problem. Medical aid fraud has been going on for decades and both patients and practitioners are responsible for this illegal activity. In fact patients often collude with practitioners to defraud medical aids without thinking of the repercussions. For medical aid members this translates into rising monthly contributions with less benefits. For doctors and other healthcare providers, it is leading to a decline in payouts and less profitable private practice. Both doctors and patients need to realise that medical aid fraud is costing the, not just money – it could even lead to jail time.
There are new financial products constantly emerging in the market which will help you fund your healthcare expenses. Most are reworked products that you may have previously known by other names. Some are truly new and unique. But before you jump ship and abandon your medical aid for these cheaper financial products, it is important to understand the differences. The fact is that there is no product that can fully match a medical aid although many offer comprehensive benefits. Medical insurance is one such product.
If you have been a medical aid member for many years, you would have noticed that the annual benefits seem to get used up much earlier as each year passes. Premiums go up every year but the benefits last you much shorter periods of time. It is true that medical schemes are under financial strain but the main function of a medical aid is to protect you from the costs of health care when you are in hospital or need chronic care. These benefits are very stable in comparison to your day to day benefits.
Over the years there have been several financial products that have become popular in South Africa as a means to fund a person’s healthcare needs. Occupational health insurance has become increasingly popular but it is important to realise that this product is not a medical aid. Nevertheless, it does offer a host of benefits for members who cannot afford medical aid cover. So what exactly is occupational health insurance and how does it work?
Injuries can arise under various circumstances in life. It can be a simple fall at home. A motor vehicle accident. An assault. Or an injury sustained in the workplace. Medical aid does not limit payout based on where or when you sustained an injury but they will need to know the details. You as a medical aid member have the protection of knowing that essential medical services are paid for by your scheme up to a certain limit every year. Unfortunately not every South African has medical aid and may have to depend on government agencies such as the Compensation Commissioner (workmen’s compensation) or the Road Accident Fund to afford private medical care in certain instances.
Medical aid in South Africa allows any person of any income level to sign up for cover. However, it is important to have a stable income in order to afford the premiums every month. If your monthly income is low and you are on a very tight budget then there is no need to write off the possibility of sign up for medical aid cover. Many schemes have special plans in place for low income workers and families. The benefits may be lower, access to hospitals restricted to certain groups and all the extra frills may be trimmed but you can still rest assured of access to at least some private health services.
In a country where the public health sector is so overburdened, even low income earners should look at medical aid if they can spare a few hundred rands per month. Without medical aid you have to opt for the government hospitals and clinics unless you have large amounts of cash at your disposal. Medical aid ensures that you will be admitted to a private hospital and receive treatment from private doctors and specialists even if your do not have cash to pay for these services upfront.
Medical aids have come a long way these days in offering services that not only take care of you when you are ill, but also keep you healthy. Gym membership is one of the added benefits that are now on offer for the members of some medical aids. Although not all schemes offer this benefit, more medical aids are jumping on the bandwagon and offering gym membership contracts. Discovery Health through its Vitality program pretty much redefined the medical aid industry in several ways but it is not the only scheme to offer additional benefits. In recent years, Momentum Health, Old Mutual’s Oxygen Medical Scheme and Bonitas have also added more services beyond just medical cover.
Medical aid does not end when the main member dies if there are other dependents on the cover. Death is an inevitability and schemes cannot instantly terminate the membership of living dependents but this does not mean that the dependents are not liable for the monthly premiums. If the premiums are not paid, the existing members on the medical aid cover are initially suspended and continued non-payment will then result in termination.
But what do you do if the main member is also the breadwinner in the family? How will you afford the cost of medical aid premiums? Fortunately there is an additional form of protection known as the premium waiver. Some schemes will automatically grant a waiver for a month or two, but premium waiver should be purchased as a standalone policy if you want relief for as much as 2 years from paying medial aid premiums.