Posts Tagged ‘medical aid’
As medical aids in South Africa tighten their belts, many new policies will be implemented that may upset some of its members. The GP-specialist referral system is one of those policies as many medical aids now restrict their members from visiting a medical specialist directly without a referral from their GP. Despite objections from medical aid members, many schemes are forced to implement this system not only for monetary reasons but also to offer the patient a complete managed healthcare service.
The past two years (2008, 2009) have seen a few small medical aids in South Africa becoming insolvent and filing for dissolution before the year end. This has left their members in the lurch, despite promises to pay outstanding medical bills to doctors and other practitioners. While medical aid members may claim to be ignorant, the warning signs should be evident to any attentive member. In these cases, it is best to switch over to a more stable medical aid rather than waiting for your medical aid to go bust.
Providing medical aid cover for your family is an essential undertaking that does not come cheap. Medical aids in South Africa can be pricey to say the least but without medical cover, you will be at the mercy of the understaffed and overworked public health sector. Family medical aid usually involves the main member along with an adult dependent and one or more child dependents. At times other dependents, like a grandparent, may also be added to the medical aid cover.
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Medical aids in South Africa are not cheap but the number of medical schemes with different plans and options will contain an affordable medical aid that is right for you. It is not a matter of joining the ‘best’ medical aid. All medical aids offer various plans which are similar. The decision you make for your medical aid option depends on your health care needs as well as your budget.
Medical aids in South Africa are essentially a health insurance. In the event that you need to access medical services, your medical aid will ensure that you have financial cover to meet your bills. Many practitioners, pharmacies and all private hospitals claim directly from your medical aid so as not to inconvenience you with up from cash payments.
Nevertheless the contract exists between you and your medical aid and any provider who is contracted into a medical and dealing directly with your scheme is actually doing you a favour.
Being a member of a medical aid does not guarantee that all your medical bills will be paid directly by your scheme. Certain medical aid restrictions and providers contracted out of medical means that you have to pay cash for these services. In most instances, your medical aid will then reimburse you directly for these costs.
If you have paid cash for any medical service, ensure that you get a statement and a receipt from the provider. While the receipt verifies that cash was exchanged for the service or product, the provider’s statement will contain all the necessary details for your medical aid to process the claim. In this instance, you medical aid will then pay you directly – either by check or via EFT into your bank account.