Is it time to re-evaluate your medical aid plan?

Published on 26th September, 2023 at 10:55 am

With pockets increasingly under pressure, and the year-end looming, here’s what experts want you to know before deciding to join a scheme – or change your existing plan.

Reading time: 3 minutes

In this article you’ll learn:

• How to weigh up your medical aid options.
• How you can qualify for a Wealth Bonus Health Booster.
• What experts suggest to get the most out of your medical aid plan.

Welcome to medical aid open season

As the year ends, your financial plan should be a focus. Medical aid schemes know this, which is why, during November and December, most allow their existing members to upgrade their plans.

Since the choice to downgrade a plan is often financially driven, most schemes allow this change throughout the year.

What to look for in a plan

Reflect on the past year and ask yourself these questions:

1. Was your existing plan enough this year?

Between your medical savings account running out mid-year and unwelcome surprise bills your plan didn’t cover, an upgrade could be in order. Or there may have been a diagnosis in your family this year that would warrant an upgrade to manage the treatment, notes Jeremy Yatt of Fedhealth, one of Sanlam’s preferred medical schemes.

2. Where are you now in life?

“Young adults are considered healthy compared to older members. They commonly consider a basic hospital plan or a network plan offering limited day-to-day cover in a network setting,” says Serisha Singh of Bonitas, a preferred medical scheme of Sanlam.

Couples who are planning to grow their family might consider a plan that has generous maternity benefits. If you have school-going children, benefits that cover dentistry and orthodontics would be among your options.

If you’re thinking about starting a family, make sure you’re financially ready. Read more here.

3. What can you afford?

Budget is a key factor in selecting your plan. “Contributions shouldn’t exceed 10-15% of your monthly household income,” Singh shares as a guide.

While Yatt says if you’ve lost a significant portion of your income, you might have to consider downgrading. However, Singh notes that although you may save money on contributions, you mustn’t leave yourself – or your family – without adequate medical cover.

Many medical aid plans offer more than just benefits for unplanned hospital or doctor visits. Read this article to learn how to get the most out of your medical aid.

Don’t miss out on what your plan can offer

Get network-savvy

Some schemes, like Bonitas, offer network-based plans, which means you can save up to 15% on selected scheme-approved providers.

Maximise your benefits

Look for preventative healthcare and wellness checks offered by a medical aid – they can help with early detection of conditions that would otherwise further set you back financially if left undetected.

Why it pays to partner with a financial expert

Make any medical aid decisions with your eyes wide open by meeting with your financial planner. They can identify your potential blind spots by completing a needs analysis.

For example, if you want to downgrade to save money, but the downgraded plan means ultimately spending more on a specialist’s fees for a procedure you expect to have next year, a financial planner will highlight this.

Meet with a financial planner today to help you make the right decision.

Minding the gap: the solution

You may still have the nasty shock of bills for specialist treatments not covered by your scheme. This is where gap cover becomes useful. Used in conjunction with your medical aid plan, it removes the financial stress of anything from a tonsillectomy to the birth of a child.

“It gives you the freedom of choosing a specialist who will give you the best care, regardless of your medical scheme and regardless of the rates,” says Samantha Drake, Senior Manager of Sales and Marketing: Sanlam Gap Cover.

Are you looking to earn more Wealth Bonus? Bonitas and Fedhealth members who take out a Sanlam Matrix Premier risk policy with Wealth Bonus qualify for 15% more Wealth Bonus.