With the country’s grim economic outlook, many South Africans will try and tighten their belts, but cancelling your medical aid should be last one your list says Alexander Forbes Health, despite increased costs around affordability of schemes.

MD of Alexander Forbes Health, Bütsi Tladi said many of the company’s more than 200 corporate clients had raised concerns about the affordability of the different medical aid schemes. “Unlike in previous years, where we did not see a drop in membership, we are now very worried that financially stressed families will cancel their medical aid cover,” Tladi said.

To address these concerns Tladi says Alexander Forbes was looking at more affordable and appropriate plans for their clients. Most medical aid schemes offer basic primary health care insurance cover, designed to offer affordable medical aid care to the previously uncovered population. Health insurance covers unforeseen medical emergencies and does not cover Prescribed Minimum Benefits.

“Health Insurance is not a substitute for medical aid schemes and must not be confused as such. We are now able to offer solutions for young talent in organisations whose starting salaries excluded them from medical scheme cover. Similarly, low-income earners can now have some level of cover.”

Every year the cost of medical aid cover goes up but that does not always mean that the medical savings amount will increase too. In some cases, there may be a slight decrease or the amount stays the same. Tladi says that this benefit can be extended by making use of network service providers. “We encourage the use of networks as these lead to less gaps in cover. Schemes need to work harder in ensuring that the networks in place give access to all members.”

Tladi says you can make your medical aid cover go further by:

  • Using network doctors
  • Using network optometrists
  • Using network hospitals
  • Using network dentists
  • Using network approved pharmacies

Gap cover, explained Tladi, is an insurance policy which covers certain medical costs that your medical aid may not cover while you are in hospital. “It is important to note that there are certain things that gap cover will not pay for. This includes but is not limited to the following:

  • Routine medical check-ups
  • Medical procedures that are done by non-network service providers
  • Home based care
  • Co-payments for procedures that you are in a waiting period for

“It can be overwhelming to decide on an appropriate medical aid scheme and the cover that is right for you. This is why it important for potential medical aid scheme members to speak to a consultant who is knowledgeable and who would be able to guide members on how to select the appropriate cover. An adviser will guide members on how to select appropriate cover in a manner that maximises benefits and manages premiums. This selection would include use of networks and gap cover. It is about selecting the most appropriate option after considering the unique circumstances of each member.”



Issued by Corporate Image on behalf of Alexander Forbes