Maximising Your Medical Cover: Tips for Protecting Your Health and Your Wallet
Making sure your family has the best possible medical cover is a top priority but achieving that goal can be challenging. “Medical plans are complex, and there are many products, including gap cover to ensure high costs don’t derail your finances,” says Michael Emery, Marketing Executive at Ambledown Financial Services. “Working out which plan is best for you, and what the terms mean, is time-consuming, and mistakes could have dire consequences. Building a relationship with a reputable advisor remains the best way of ensuring you understand what the options are, and what’s best for you.”
Can I reduce the cost of my medical cover?
The starting point is to understand your personal and family healthcare usage patterns and compare them to the benefits your current plan offers. Only once you have this information can you make informed decisions about whether a different medical plan would suit you better and whether gap cover should be added. We recommend speaking to a registered financial advisor for guidance.
What happens if I cancel or downgrade my medical cover?
Cancelling medical cover altogether is a high-risk decision. It increases your financial exposure should you face a serious medical condition and could make re-joining a medical scheme later more complicated. Downgrading to a lower plan might help with costs, but it’s important to ensure the benefits still meet your needs. Expert advice can help you find a medical scheme with better value for money, paired with the right gap cover to reduce shortfalls.
How can I get more value from my current plan?
One of the simplest ways to maximise value is to use healthcare providers who are part of your scheme’s network. These providers’ rates are typically fully covered, while out-of-network suppliers may charge more than your scheme covers, which can result in additional out-of-pocket costs. Gap cover can help in cases where there’s a shortfall between your scheme’s rate and what’s charged, but it does have limitations.
Does gap cover pay for all in-hospital shortfalls?
Gap cover is generally designed to cover the difference between what a medical scheme pays and the actual cost of authorised in-hospital and specified out-of-hospital procedures where specialists charge above the scheme tariff. However, it may not cover everything, for example, medication after discharge may not be included.
Does gap cover pay for everything a medical scheme doesn’t?
A common misconception is that gap cover pays for all uncovered medical costs. In reality, gap cover only comes into play when there is a shortfall between what your medical scheme pays and the actual cost of the treatment and only for benefits that the medical scheme itself covers for in-hospital and specified out-of-hospital procedure. If a medical scheme does not cover a certain procedure at all, gap cover will not apply.
In conclusion, Michael Emery (Marketing Executive, Ambledown Financial Services) says one cannot overestimate the value an expert advisor can add. “Medical schemes and complementary products like gap cover and medical insurance are carefully designed for specific population groups, and care needs to be taken to sign up to one that is suitable to one’s life stage,” he says. “In every instance, members need to understand fully what is and what is not covered by a medical scheme or gap cover policy, and an advisor can help ensure you make the right choices. Consult with a reputable advisor to find the best medical cover tailored to your needs and to ensure you and your family are fully protected,” concludes Emery.
Disclaimer: This is not a medical scheme, and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.
