By Portia Mahlalela, Alexander Forbes Health Regional Executive.
In the next two months, medical schemes will announce changes in pricing and offerings for the year ahead, and often these options can make choosing the correct medical aid seem even more daunting for the consumer.
With so many different plans in the market, there is much to review, including understanding the changes, terms and fine print in these options.
Technology has made access to information very simple, so consumers can find information on the different options on offer from their chosen Scheme. Medical schemes make all this information available on their websites, however, not everyone understands the detail provided and what it means, and due to time constraints, may not read through the details. This could lead to them only realising after they have chosen a plan that it was not the right fit. This is where a medical aid consultant or broker’s role comes into play.
Healthcare advisers are usually independent of the medical scheme and provide consumers with an impartial overview of medical aid scheme and options available. They have an in-depth understanding of the various medical schemes on offer which enables them to consider the consumers’ current and potential future medical needs. This knowledge enables appropriate advice on the plan to choose, the benefits, as well as the co-payments or deductibles that may be applicable on the various options.
The medical aid broker advises on various matters that the consumer may not fully understand, and may include some of the aspects below:
- Suitable plan for their current medical needs and future anticipated needs
- Benefit structure of the medical scheme (medical savings, self-payment gap, traditional structures)
- Explaining the contribution and annual increases
- Co-payments and deductibles
- The claims procedure for a particular plan
- Exact structure of benefits like chronic medication, medicine formulary, designated hospitals, day to day benefits, prescribed minimum benefits.
Medical aid consultants or brokers are regulated and expected by law to provide a consumer with best advice. The legislation also stipulates how much brokers may receive as payment for their services. South African legislation allows brokers to receive commission of 3% up to a maximum of R94.77 excluding VAT per month of a member’s contribution for their services. Once a consumer has appointed a medical aid broker either individually or through their company, the broker is liable to provide its advisory services to the consumer.
There are several rules and regulations on any medical scheme plan that consumers may not be able to decipher. It is therefore important to seek advice from a medical aid consultant who will provide the best advice to suit your budget and your circumstances, especially at this time of the year when changes must be made to one’s choice of plan.