Spring clean – Extortionate Medical Aid premiums

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Medical aid premiums – out of control – what to do

It’s coming to the time of the year where you should be reviewing your medical aid plans with a view to changing from the first of January. The inflation increases of this core part of many of our budgets continues to spiral out of control. Every time an increase comes through that is above inflation, then the problem compounds into the future. Every year thousands of South Africans ‘buy down’ on their schemes – the costs are just unaffordable and unsustainable. So how do you decide what plan to take, and what provider to use?

Medical aids are hamstrung by regulations, and cannot refuse membership to anyone, no matter their health – this is quite different to the ‘life’ industry. The only penalties they can impose is a 3 month claim restriction, 12 month condition specific exclusion and late joiner penalties. In my experience they will use these restrictions almost without exception, making changing providers a nightmare for an individual who is not on a compulsory group scheme. You have to pretty fed-up with your current provider to go down this route – I know, I did it.

So the first thing anyone can do is check that they are on the right plan with their current provider. A Hospital plan is an absolute must, so work from there. Yes you can save a couple of hundred rand by using a ‘network’ option but there will be the risk that your ‘preferred’ doctor will not be accredited at that network, creating significant out of pocket expenses.
Next step – what were your claims like last year, and what do you expect them to be this year? You can usually find this out from the tax certificate the medical aids send you every year, or give the provider a call and ask for it. If you (and your family) are generally healthy – you are probably subsidising individuals and families that are not. Consider that it might be more useful to put your premium saving into a ‘safety net’ that you can use for any expense, not just a medical one. Have a look at this blog for some hints on how to save with a different approach.

Tricked you! Make savings a game : http://kerenga.com/savings_a_game/#more-886

If you’re worried about ‘co-payments’ on a hospital plan, or large dental expenses (a crown or root canal for example) these could be covered with a much cheaper ’gap cover’ product, and you won’t need to take the much more expensive plan upgrade. Plans can usually be changed at least once a year, some providers allowing it more often, so if the family’s health changes then you can upgrade the next year. It is hospital stays where the costs can literally bankrupt you, not your spouse’s preference for R6k glasses frames.

Need help in deciding the best plan? Want to know know more about gap cover? Give me a shout.

Author Dawn Ridler 

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