Medical aid crucial during hard times



When times are tough and funds runs dry, cutting down on ‘grudge’ purchases, such as insurance, is often one of the first things beleaguered consumers do to relieve some of their financial pressure. There are more smart ways to save money, and skipping out on health insurance could be catastrophic. “Cancelling your medical scheme membership to save money in the short term may in the longer term cost you and your family dearly,” cautions Liberty Medical Scheme’s executive principal officer, Andrew Edwards. Without medical scheme cover, people have no choice but to rely on the overburdened, underserviced state healthcare facilities – or fund the costs out of their own pocket, he points out. “Younger, healthier people could pay for the occasional visit to the doctor and medicine out of their own pocket, but what if they needed specialist attention because of an unexpected illness or a tragic accident?” says Edwards.

Through medical aid cover, members can access some of the best private hospitals in the world, often serviced by pioneering specialists and experts in their respective fields, thus ensuring considerable peace of mind. In addition, medical schemes pay for many other healthcare needs such as nursing, surgery, dental work, medicine, physiotherapy and eye-care. Even on entry-level and low-cost options, medical scheme members can still access excellent doctor and private hospital networks. More importantly, medical scheme membership protects members financially if they suddenly have to pay large, unexpected medical costs. In addition, they can usually rest assured that there will be no delay in medical treatment. People who don’t have health insurance tend to wait until their condition is at its worst and use the emergency room to receive care. This results in large bills from doctors and facilities that often go unpaid.

To recoup those funds, hospitals are often forced to charge more for services to everyone across the board. Studies also show that uninsured individuals don’t receive the same quality or amount of preventive care those with cover enjoy and may be putting themselves at greater financial risk than their insured counterparts. Medical scheme members, on the other hand, are more likely to make use of preventative care benefits offered by schemes, using it for annual check-ups and other diagnostic tests that can catch serious medical conditions early when they are still treatable. Some of the latest research shows that people with health cover are also found to be mentally and physically healthier. Consumers of healthcare should also be aware of the fact that medical scheme cover and health insurance products such as hospital plans and other gap/top-up insurance products differ in that they serve different purposes.

“Mainly aiming to provide additional cover because of what healthcare providers charge, gap/top-up cover plays an important supplementary role. Medical scheme membership, on the other hand, is indispensable insofar is it provides comprehensive cover, including cover for Prescribed Minimum Benefits (PMBs). In addition, medical schemes are regulated by the Council for Medical Schemes, thus ensuring compliance with the Medical Schemes Act, to the benefit of its members. Contrary to public perception that all medical scheme options are expensive, schemes offer affordable, low-cost and entry-level options to suit all members’ needs, Edwards adds. “As sound medical schemes revise and review their scheme options every year to ensure that the benefits appeal to members, meet their needs and are appropriately priced and affordable, medical scheme membership is the wise option, ensuring peace of mind in the most difficult circumstances,” concludes Edwards. Meanwhile, president Jacob Zuma has also pledged the ANC’s full support for the National Health Insurance. The project is being piloted at identified hospitals across South Africa and aims to bring affordable, quality health care to the poorest of the poor.