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.
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.