Every medical aid has several options to suit different budgets and individual needs or preferences. These options are known as plans and are pre-structured. In this way a prospective member can choose the best medical aid option for themselves and their family. Medical aid options cannot be tailor made for an individual – you need to select from the existing plans. However, many medical aids or affiliated insurance companies now include additional options like gap cover which will make up for any shortfalls within a specific plan. Understanding the difference between medical aid options is important in making a decision on the cover that bests suits you. Price should not be the only factor and one option may not suit another depending on individual and family health care needs.
Different Options on Medical Aids
All medical aids have similar options and the price range is usually within the same range. This can be simply divided into :
- Comprehensive option which is sometimes referred to as a full medical aid because it includes an out-of-hospital or day-to-day benefit.
- Hospital option which lacks the out-of-hospital/day-to-day cover.
It is important to bear in mind that these options have different benefits. A substantially cheaper medical aid option is usually not the same in terms of benefits as a more expensive option. This is a common misconception among medical aid members – no single medical aid provides a cheaper option that has significantly better benefits than other medical aids offer for the same price. Ultimately with any medical aid option, you get what you pay for, irrespective of the scheme you are with.
Comprehensive Medical Aid Options
A ‘full medical aid‘ is comprehensive cover with both in-hospital and out-of-hospital benefits. This means that the medical aid will bear the relevant costs of any treatment conducted when hospitalised or on a day-to-day basis when visiting a doctor or other service provider out of the hospital environment. Non-essential service, cosmetic procedures and unapproved therapies are usually not covered.
Hospital Only Medical Aid Options
A hospital only medical aid option, often referred to simply as a hospital plan, covers treatment when a person is hospitalised. Day-to-day outpatient benefits are not included and a medical aid member has to pay for this on their own. As with a full medical aid option, only essential treatment that is conducted within a hospital is covered by the scheme. These options should not be confused with hospital cash back plans which are not medical aids but health insurance that reimburses a person for each day in hospital.
Chronic Disease Options
These options are included within both the full medical aid cover and a hospital only plan. It covers the drugs needed on an ongoing basis to treat chronic conditions as well as medical services needed to manage these conditions. Chronic cover has an annual limit but the costs of certain conditions referred to as prescribed minimum benefits (PMBs) are covered throughout the year even when the chronic benefit has been exhausted.
Best Medical Aid Options
The best medical aid option for a person or family is dependent on their health care needs and budget. A younger healthier person may opt for a hospital plan only. A person with constant medical needs, families with young children or old members and those with chronically ill members may need comprehensive cover. However, it is not simply a matter of whether to opt for a full medical aid option or hospital plan only. The level of benefits are another important consideration and higher benefits do mean higher monthly contributions. However, the advantage offered by higher benefits outweighs the total annual contributions.