Because medical scheme plans and medical cost tariff structures differ, having medical cover doesn’t necessarily mean that you won’t have to fork out extra money at some point for medical care.
Most medical scheme plans – especially those that are more affordable – have a limit to what they will cover. In other words your family might be covered for 100% of the National Reference Price List for Health Services rate (or your medical aid’s own rate) for dental expenses up to a maximum of R12 000 per year. There will be similar limits on visits to your GP and prescription medicine. If you exceed these limits in one year, you will be required to pay for your medical expenses yourself – and these costs can escalate at an alarming rate. So it makes sense to contain your medical costs as much as possible to make sure that you don’t go over the limit.
Here are some pointers:
- Choose a doctor that charges your medical aid rate, or as close as possible to your medical aid rate. Because your medical aid will only cover doctor’s visits up to their specified rate, which doctor you see won’t affect how quickly you reach your limit, but it will save you a considerable sum. Some medical aids will provide a list of doctors in your area who charge their rate.
- When getting prescription medication, always ask if there is a generic alternative. Unfortunately generics are still viewed with scepticism by many people, partly because people assume that ‘if it’s cheaper, it must be inferior’. The fact is, however, that generics contain exactly the same active ingredient as the ‘branded’ drug, and will therefore have the same effect. The only difference is that they do not carry the same ‘brand’ name and, for this reason, are cheaper. Patents are put in place for a period of time to protect the drug company who developed the drug, allowing them to recover some of the research and development costs by ensuring that only they can sell the drug for that period. A generic can be manufactured when the patent period of the original drug has come to an end. Generics are so much cheaper is that the companies manufacturing them did not have to incur the same research and development costs.
- Get authorisation if you require a hospital visit that falls outside the definition of ‘emergency’. If you fail to do so, many medical aids will not pay the full– or indeed even part – of the amount you incur while in hospital.