The benefits of consulting a medical aid advisor

Trying to navigate the several benefit options that medical schemes have to offer can be overwhelming. The good news is that most schemes offer advisors at no cost to help guide members and potential members to make the right choice of plan to suit their health care needs and budget. Advisors will also help with enrolment, as well as guide and support members with any queries.

When individuals are considering enrolling in a medical scheme, speaking to an advisor can provide essential guidance, says Zerina Richards, advisor sales manager at Bestmed Medical Scheme. “Advisors can help assess individual health care needs, explain plan options, coverage details and associated costs, to ensure that people make informed decisions that align with their medical requirements and budget.”

Significant life events such as marriage, the birth of a child, divorce, retirement, or changes in employment status can impact an individual or family’s health care needs and medical aid coverage requirements. Richards says advisors can help members navigate these transitions, adjust their coverage as needed, and ensure that they remain adequately protected during times of change.

Members can downgrade their plan choice within an existing medical scheme at any point of time. They also have the option to upgrade their choice of plan once a year. Richards says it’s essential to use this annual opportunity to review one’s medical aid coverage to ensure it still meets one’s needs and remains cost-effective.

“Advisors are well-placed to assist in evaluating current coverage, comparing plan options, and making adjustments during open enrolment periods to optimise benefits and minimise costs,” she says.

They can also provide valuable assistance if members have any issues with claims processing, billing errors, or disputes with health care providers. In addition to helping to navigate the claims resolution process, they will advocate on behalf of members, and ensure fair and timely resolution of issues. Changes in health status or medical needs may necessitate adjustments to a member’s current cover, such as adding supplementary coverage or switching to a plan with broader benefits. Richards reveals that advisors can provide guidance on available options, coverage limitations and potential out-of-pocket expenses to help people make informed decisions about their health care.

The role of the advisor also involves keeping members informed about regulatory changes, policy updates, or changes in a medical scheme’s offerings, which could impact coverage options or benefits. In these instances, advisors are able to explain how changes may affect the member’s coverage and help navigate any adjustments needed to ensure continued access to necessary healthcare services.

In emergency situations or during critical health care events, members may require immediate assistance and guidance from advisors. Advisors can help navigate urgent care options, co-ordinate with health care providers, and ensure individuals receive timely access to the necessary medical services.

“Medical aid is a significant component of financial planning. Advisors can help individuals assess the financial implications of different coverage options, budget for healthcare expenses and identify strategies to minimise out-of-pocket costs, while maximising coverage benefits,” says Richards. “Overall, speaking to advisors at these crucial moments ensures individuals receive personalised guidance, support, and advocacy to navigate the complexities of health care and medical aid effectively.”