Choosing the right scheme for you
Use this expert's family-health checklist to narrow down the bewildering number of options out there, writes Alf James
To choose the most appropriate healthcare option, it is vital to understand your family's health requirements.
Medical cover can be a significant monthly expense, particularly for larger families, so it's important to compare plans and costs to find the best option for your family's needs, according to Dr James Arens, clinical operations executive of Pro Sano Medical Scheme.
Arens says that, when planning healthcare cover, you should write down a basic medical history for each family member, including treatment they may need in the year ahead. He advises including these 10 points as part of the annual check list:
- How often do you or a family member visit the doctor?
- What types of doctors do you visit: paediatricians, GPs, specialists, oncologists, neurologists?
- How much money do you spend on over-the-counter medicine each month?
- Do you require cover for chronic medication?
- Are you planning to incur any major medical expenses this year, such as pregnancy and birth or surgery?
- What are the family's annual spectacles needs?
- How often do you visit the dentist and what are your family's dental needs?
- What annual checkups do you or family members require, such as mammograms, cholesterol tests and cancer screening or bone-density tests?
- Do you or any family members have travel plans for which healthcare cover is needed? and
- Are family members involved in dangerous or contact sports with a risk of injury?
"Budgeting should be done before you approach a broker or medical scheme, so that you are clear about the amount you are able to spend each month.
"Most medical aids have an array of options to suit a variety of pockets, from hospital plans to comprehensive cover, and various options in-between."
Arens says it is important to make sure the proposed scheme is in good financial shape.
"Once you have decided on the right scheme for your needs, satisfy yourself about the financial stability of the scheme.
"This can be ascertained by ensuring that the scheme solvency levels are above 25%; by obtaining a Global Credit Rating on the scheme - that is, the claims-paying ability of the scheme; and by looking at the claims ratio, which is another measure that gives an indication of the operational efficiency of a scheme," says Arens.
"Your broker will be able to assist in this regard.
"Finally, make sure you don't get caught without appropriate medical cover for your family's healthcare needs.
"With medical expenses higher than ever, if a member of your family needs to see a doctor or be hospitalised, and you are not adequately covered, your out-of-pocket costs are likely to be a lot higher than you might ever have planned for," says Arens.