Medical Aids & Insurance
Short payment by medical aid is becoming more common these day as more practitioners move away from NHRPL tariffs and charge private rates. Until recently, patients were not aware that they would be faced with a bill above and beyond what medical aid pays for these procedures. However, practitioners are now required by law to inform patients about their higher than medical aid rates before commencing treatments and patients have to sign a consent form indicating that they still wish to undergo treatment at this higher price.
Over the years, more doctors and other service providers in South African have opted to contract out of medical aid and charge private rates. It has been an issue of contention among medical aid members who find that they still have to pay cash to health care practitioners despite paying their monthly medical aid contribution. Even more frustrating for medical aid members is that the private cash rates charged by many doctors is significantly higher than medical aid rates. Ultimately this leads to a shortfall between what the patient has to pay and what the medical aid is prepared to reimburse, which means that patients are out of pocket.
These days your salary package is quoted as cost-to-company. This means that your actual pay as well all the benefits should not exceed the CTC amount. It gives you some flexibility in deciding in how your salary package will be structured but it can be confusing at times, especially if you are not financially-inclined. The question that most employees have is “how can I get the highest take-home pay while paying the least amount of taxes?”. Your retirement annuity, pension/provide fund contributions, medical aid and income protection are some of the tax deductions that provide you with financial protection.
Most of us in South Africa have come to accept that medical aid is a matter of necessity rather than an optional extra. If you want to access private health care services, be it your GP, a specialist, blood tests and scans or treatment in a private hospital, then medical aid is the only means to afford this level of care. But newer financial products that will help you fund your private healthcare needs are constantly emerging and medical insurance is slowly gaining ground in the South African market. Will it replace medical aid someday? Highly unlikely but medical insurance is a cost effective option for South Africans who cannot manage with the ever-increasing costs of medical aid contributions.
These days it is practically inconceivable to be without medical aid. But with diminishing benefits and rising contributions, medical seems unaffordable at times. If you have decided that you need medical aid cover then shop around carefully. The fact is that most medical aids offer pretty much the same benefits for similarly priced plans. But your needs and budgets should be factored in before you select a medical aid plan that is just right for you. Here are some tips on how to find the best medical aid.
We all want to ensure that we have the maximum cover for funding our healthcare needs should the situation arise. While medical aid is the primary option for doing so, it may not always pay for every service, procedure, test or drug. Sometimes it is related to doctors who charge above the rate that the scheme will pay. At other times a medical aid may feel that a procedure is unnecessary or that they are only willing to cover a generic drug. Whatever the case, South African medical aid members are finding that they have to frequently top up on bills from their own pocket these days.