Managing your medical expenses

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Taking charge of your medical expenses has become increasingly important as healthcare costs continue to rise. Finding the right healthcare cover, that is affordable and meets your healthcare needs, is the first step.  At this time of year, medical aid members are reviewing their options to ensure they make the right decision regarding access to the highest quality of healthcare, for the year ahead. It’s a delicate balancing act that needs to support your physical, mental and financial wellbeing. 

Lee Callakoppen, Principal Officer of Bonitas Medical Fund, provides some insights into how you can save on healthcare costs by using networks, Designated Service Providers (DSPs), opting for virtual care and generics to stretch your benefits. 

Using networks 

One way of reducing monthly medical aid contributions, without compromising on care, is to use a network plan. Generally, these are around 15% cheaper but, you must agree to use network hospitals. 

‘We implement networks to negotiate the most favourable tariffs for our members so they can avoid out-of-pocket expenses and get more value,’ explains Callakoppen. ‘Using networks also means you can reduce or eliminate co-payments.

‘Members are seeing the value of hospital networks,’ he says. ’Around 1.2 million open scheme members are on a network option, accounting for 53% of the industry.’  

If you choose to go with a network plan, ensure there are doctors and facilities in your area.  Check what co-payment might have to be paid for not using a DSP or network. Don’t forget that network options are waived for emergencies.

Co-payments

Medical practitioners and hospitals often charge more than medical aid rates, this means medical schemes seldom cover the entire bill.  A co-payment refers to the outstanding portion of the account, for which you will be responsible.  Co-payments vary from one scheme to another.

Tariffs and rates of payment 

Every medical scheme has a rate of payment: The amount the scheme will pay for that service.  Some providers charge different rates known as the Scheme Tariff. Members often misunderstand that 100% of the scheme tariff/rate doesn’t necessarily mean 100% of the account or what you will be charged.  Read the details of your plan carefully and know what rate is being paid and the benefit limits to avoid any surprises.

Virtual has the Edge 

Technology is driving innovation and with the introduction of virtual integration and digital interventions, this is an ideal way to access healthcare, while stretching your benefits and minimising your monthly contribution costs. 

Designated Service Providers (DSPs)

Healthcare costs in South Africa are unregulated, which means providers are free to charge any tariff, However, by using DSPs you can limit out-of-pocket expenses and co-payment and stretches your annual benefits.

‘Bonitas networks include over 4 000 GP practices, a pharmacy network of around 2 500 to dispense chronic, acute and over-the-counter medicine, around 3 000 dental practices and an optical network of over 2 300 practices.

Use generics 

A generic is the exact copy of brand-name drugs.  They have the same dosage, intended use, effects, side effects, route of administration, risks, safety and strength as the original. 

But they are much cheaper than the originals. – on average between 30 and 80% less.

The Medicines Control Council (MCC) carries the responsibility of making sure that generic drugs are safe and effective in South Africa. Generic manufacturers have to prove their medicine is bioequivalent to the innovator brand before a product is allowed into the South African market. 

Benefits

The benefits you receive vary depending on the plan you choose, make sure you read the fine print to understand what is and isn’t covered. 

Gap Cover

Gap cover is an insurance policy, designed to cover the difference between what the medical scheme pays and the service provider charges for in-hospital procedures/treatment and specified outpatient procedures.

The advantage of having a Gap Cover is that you are insured against some of these additional costs.  However, never assume that all costs will be covered as the payment options depends on the product you have taken out, which is subject to limits and exclusions and you might still be asked for a co-payment.

Medical savings 

A medical scheme allocates an annual fixed amount for medical savings – you need to know what this allocation is and whether you feel it will be adequate for your needs and you are able to tap into your savings for a number of medical expenses.

Managed Care

One of the key healthcare trends is the rise in non-communicable or lifestyle diseases, such as diabetes, high blood pressure and cancer. ‘80% of these conditions are caused by lifestyle risk factors,’ explains Callakoppen, ‘which is why we offer a range of Managed Care programmes aimed at assisting members understand and manage chronic conditions include cancer, diabetes, HIV/AIDS, mental health and back and neck pain.’  

To this end use the supplementary benefits offered by your medical aid to save on significant day-to-day expenses such as: Blood pressure medication, cholesterol, blood sugar and Body Mass Index (BMI) measurements through to mammograms, pap smears and prostate testing.

You can ‘work smart’ with your medical aid benefits. And wisely. Not only will you have access to quality healthcare but you will be able to extend your benefits. 

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