10 Reasons to have a good Medical Scheme.

by SAPA


Think about a medical worst-case scenario. You’re trapped under a truck, your head is bleeding and you are sure your leg is broken in at least one place. There are sirens, ambulances, the fire brigade, and the last thing you remember before waking up in the ICU is being put on stretchers.

This type of accident scenario is what most people think of when they think of reasons why a medical scheme is necessary. And let’s face it, under these circumstances, good medical care could save your life.

And yes, medical schemes and hospital plans are expensive, but it might be even more expensive not having one.

But being well cared for after accidents is not the only reason why having a medical scheme is important. Here are some others.

The end-of-the month flu bout. It’s three days to payday and you’re down to your last R20. You’re going to be living on potatoes and the smell of an oil rag for the next 72 hours. And then you get ill. Very ill. Your chest is rattling, your head is so sore it feels like it wants to part company with your body, and you have forgotten what it is like to breathe through your nose. And your doctor works on a cash-basis only. Except if the account is sent directly to your medical scheme. Need I say more?

Sudden expensive medication. For the same flu bout, you need medication from the chemist – and it doesn’t come cheap. In fact, even with opting for the generics, the total bill for this comes to R237,11. And right now, you just don’t have it. But fortunately your chemist sends the bill to your medical scheme and you end up having to pay a levy of a few rand. Now that you can do.

Serious diseases. Cancer, emphysema, diabetes complications, ongoing heart problems – these are things no one ever thinks will happen to them. But when they do, and the onset could be sudden, the cost of things like scans, X-rays, pathology tests, ultrasounds could run into thousands. Not to speak of lengthy hospitalisation and expensive operations. And few people have that kind of money lying around. Most medical schemes and hospital plans will cover these things in full.
The young and the old. Few people use their medical schemes much when they are in their twenties, or even thirties. But their contributions make a big difference to funding the medical costs of the older members. And young people get older, and one day their costs will be funded by new and incoming younger members. And no, it is not a solution to join when you retire, as your premiums will be much higher than those of someone who has been a member for twenty years. This is understandable. And a medical scheme is essential for retired people – this is probably going to be when you need it most.

Eye problems. Welcome to your forties. Here is your complimentary pair of reading glasses. Not really, but you get the picture. Few people get past middle age without some vision problems. These can range from minor to serious – and prescription lenses (even with cheaper frames) don’t come cheap. And you might need new ones every two years.

Not state-of-the-art hospitals. While there are some state hospitals that are fine, in fact, downright fantastic, there are major funding and staffing problems in many of them. In several of the hospitals the actual operations performed are excellent, but the problems come in with post-operative care of patients. While not all private hospitals are completely fantastic, the level of care you receive and the facilities available to you are likely to be better. And so it should be, because most of them are jolly expensive. If your life is hanging by a thread, the last thing you feel like dealing with are no sheets on the bed or dirty toilets. Or waiting endlessly in a queue while you are bleeding. So pay your medical scheme contribution with a smile.

Peace of mind. We spend an inordinate amount of our time worrying about money. If you have a family, and are a wage earner, unless you have won the lottery, you would not be able to foot the bill if your family of five were in the same car accident and all landed in hospital. Whereas medical schemes do have limits, most hospital costs are at least paid for. So now you can sleep at night.

Ambulances. If you’ve had a heart attack and are lying on the floor of a restaurant, you want the ambulance to get there without delay. Sometimes state ambulances are very swift, but there are also horror stories about badly injured or ill people waiting hours for an ambulance. Being a member of a medical scheme usually entitles you to use a private ambulance.

Maternity costs. Having a baby is expensive - even if there are no complications. Medical schemes will not cover you for your pregnancy if you only join once you are pregnant, so if you are planning to have a family, and you’re not a member yet, make a plan as soon as possible.

Check-ups. You know you should go to the dentist, the oral hygienist, the GP or the homeopath for regular check-ups. But you don’t, because it is expensive. You wait until something goes wrong, and then you go. And it ends up costing you three times as much. Prevention is indeed better than cure. And within specific limits, your medical scheme will pay for these check-ups.

What value would I add to you the consumer as a healthcare advisor?

Advise you as a member of a medical scheme on:


• Which medical scheme to select

• Your rights when changing medical schemes

• The consequences of changing schemes

• The details and procedures applicable to your new scheme

• Annual option changes

• Changes in legislation and the impact thereof

• Giving on-going feedback on the financial and administrative stability of your chosen scheme

Which medical scheme to select

There are a significant number of medical aids to choose from, and each of these has a number of benefit options which complicates the selection process for a member without the support of an informed and experienced professional.

Medical schemes and administrators cannot be expected to supply independent information on how their products compare to their competitors, and which of their options would be most suitable to the health needs of the member.

This is where the Healthcare Advisor (like myself) adds value as they have clients across a broad range of medical schemes and will be able to identify these issues and advise members accordingly.

Your rights when changing schemes

The legislation governing the medical scheme environment is complex and medical schemes often abuse the fact that most members do not understand their rights.

We can assist you to ensure that the law is applied in the manner that it was intended to be applied.

The consequences of changing medical scheme membership

There are many important issues members need to consider when they decide to change medical schemes during a calendar year and these are often overlooked with dire consequences to the medicals scheme member. Some examples:

 Savings account claw backs: Members who have spent their full annual allocation will have to repay the proportion relating to the balance of the year when they leave the medical scheme

 Pro-rated benefits: Joining a new medical scheme partially through the year will mean that members only have access to a pro-rated portion of the benefits offered by the new scheme.

 Focusing on cost savings and not on the benefit reductions that may accompany these cost savings may leave the members at risk

 Not considering changes in any specialized benefits. Members changing schemes with specific medical conditions might not properly evaluate the level of benefit on the new scheme for these specific conditions.

Member education

It is normally the Healthcare Advisor that spends time with individuals, or in group sessions educating them about the benefits, requirements and potential pitfalls of the members’ chosen medical scheme with regards to issues like hospital pre-certification, chronic medication applications, generic versus ethical medication cover etc.

Annual option changes

Most medical schemes only allow members to change options once a year and this is the only opportunity a member gets to ensure that they are on the correct health plan to suit their health and financial needs.

Healthcare Advisors add value by proactively assisting the member to evaluate the option they are on. It is also in your best interest as a member to be aware of developments within other medical schemes over this period so that you can compare your current scheme against others. The Healthcare Advisor fulfils a very real and valuable role to medical scheme members over this time.

Changes in legislation and the impact thereof

Healthcare advisors make sure members are notified of these changes as you may be personally affected by these changes.

Changes to the benefit structures and/or procedures applicable to your scheme and the impact thereof

Again Healthcare Advisors offer this service to members, where medical schemes are slow to disseminate such information.

Ongoing feedback on the financial and administrative stability of your chosen scheme

No medical scheme will admit to falling solvency ratios and financial pressures, which could translate into higher than average increases for members. Healthcare Advisors are able to keep members informed of the financial stability of schemes, and very often are able to warn members in advance of what to expect from a medical scheme that is under financial pressure.

I discussed a couple of areas where I can add value in your lives, either as an individual or as an Employer. Please do not hesitate to contact me should you have any questions.

Why do you need a financial advisor?

 

 Personal finance has become extremely complex. Legislation and the products themselves have left the world bewildered due to the fact that the financial environment changes on a daily basis. Not even the most financial literate have the time or the expertise to keep up with developments.

 

A financial advisor’s whole career is based on providing sound financial advice. This cannot be achieved unless he/ she is fully aware of there surroundings in the field and therefore it is fully up to you to decide if you’d like to have the long – term quality impact that a financial advisor can enrich your life with.

  

Choosing a financial advisor


10 Potential mistakes in choosing a financial advisor

1. Choosing the advisor due to distance. Find an advisor that applies to your needs, not someone that is necessarily close to you.
2. Going with your bank advisor- There are excellent bank brokers out there, but it might be good to get a second opinion.
3. Choosing the first advisor that you get a proposal from. This is one of the biggest mistakes to make. A financial advisor is a specialist in the field and therefore it is better to get more than one opinion from more than one broker.  
4. Sticking with you advisor even though you are unhappy with the service provided. If you have informed the advisor that you are not happy with the service provided and nothing has changed, you are more than welcome to find someone better suited.  
5. Staying with an advisor because he/ she makes you feel guilty- this is a domino effect caused by several of the mistakes listed here. Keep things professional.
6.  Choosing the cheapest advisor- Always focus on quality and not quantity.  
7. Choosing an advisor that wines and dines you- This is a benefit some companies do on a standard basis, but it is important to get good service and not just good food.
8. A personal friend- One should rather not interfere business with you personal life.
9. Going with an advisor because it is a friend of someone you trust
10. Basing your decision on their vehicle