Doctors' bills, hospitalisation, and medicines are not cheap. How much should you set aside for healthcare – and where should you put it?

If you can afford any kind of medical aid or health insurance, you need to choose carefully so the type of coverage you have meets the needs of your family. Many people rely on public health care, visiting state clinics and hospitals. But in spite of the high percentage of government funding allocated, these are plagued by long queues, failing equipment and shortages of trained staff. 

Private health care is generally regarded as good in comparison, but can be hugely expensive. On average, South Africans pay 439.00 for a private doctor’s visit, ranging from 300.00 in a township to 600.00 in a prime area, according to a Justmoney survey this year (excluding specialists’ visits or any medication prescribed).

If you can afford private healthcare the choices can be confusing, with around 80 medical schemes, each with several benefit options, according to the Council of Medical Schemes. Medical Aid contributions per average beneficiary were 1 727.00 a month in 2017 (the most recent industry documentation), and that will have increased.

‘For a general South African medical aid, you need to budget up to 10% of your salary for the family', says Jillian Larkan, head of healthcare consulting at GTC Financial Services. If choosing a scheme for the first time, or considering changing from the one you're unhappy with:

* Ask what the premium increase will be for next year. If you can’t afford it, consider downgrading your plan – for instance, from comprehensive to saver, or even to hospital cover only.

* Ask yourself how much chronic cover you need. Medical schemes must offer you 270 prescribed minimum benefits (PMBs), including 25 chronic conditions. Basic conditions such as diabetes form part of the PMB 25 ‘must cover’ illnesses, for which your medication will be paid from the scheme’s pool, not your day-to-day savings.

* Ask about required co-payments for surgery, and how they compare across options.

* Ask about hospital cover and specialist cover, and how it compares with other plans.
* Don’t forget to ask whether there’s a hospital network limitation on your considered plan (where you must use certain hospitals or face making a co-payment), and how much premium you’ll save by belonging to it.

* Ask about the cover for day-to-day expenses, and consider those you incurred this year: will your selected medical aid offer enough for the year ahead, or should you upgrade?

* Ask if the scheme has a preferred doctor network (where the medical aid pays the fee in full), and where they’re situated, so you don’t end up with co-payments or high transport costs.

* Ask yourself what your requirements are and if they could change – are you getting married or starting a family? If so, ask about maternity benefits on different options and benefits for children. In general, if you’re single, younger and healthy, eat sensibly and follow an active lifestyle, a hospital plan could be all you need, says Larkan. If you’re older than 45, married or have kids, aim to upgrade to a savings plan or comprehensive plan.

A gap or top-up policy covers the shortfall between what your medical scheme pays and what your service providers charge if you’re hospitalised – which can be considerable. Take one out as soon as you’ve joined a medical aid, advises Larkan. ‘Members sold medical aid products which state that they cover 100% often fail to understand that they pay 100% of the scheme rate – not 100% of the costs you incur.’

Gap cover is available from around 200.00 per family a month, for up to around 160 000.00 cover per beneficiary a year.

This is a supplementary insurance option that’s unrelated to a medical aid. It offers benefits for out-of-hospital procedures like doctors’ visits and medicine, dentists’ visits and X-rays. A select few cover emergency hospitalisation up to a set limit. Others pay out cash for non-medical expenses if you're hospitalised for more than 48 hours and unable to work. These are based on the time you're in the hospital and designed to cover not only doctors' and hospital charges, but things like electricity, water and school fees when you're unable to earn. You get to choose how you spend it.

Cover for primary care plans ranges from around 300.00 per the main member, with a few covering families at an additional fee. Hospital cash plans are available from around 50.00 a month, and for children from about 12.00 a month.

Jet Club members have free access to Jet Club’s helplines. For support and advice on depression or babycare call:

Personal Health Advisor
SA & Namibia
0800 0045 45
Botswana, Lesotho & Swaziland
+2711 991 8258

HOW TO BUDGET FOR MEDICAL CARE HOW TO BUDGET FOR MEDICAL CARE Reviewed by Jet Club on October 03, 2019 Rating: 5
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