Making the most of your medical aid

For many South Africans, navigating the medical scheme space can be very daunting.

Firstly, you have to come to terms with the jargon-loaded language of medical schemes. What is a PMB, or  “co-pay”?

Secondly, we sadly often regard medical aid as something of a grudge purchase that we ignore until we need to use it. This means medical scheme members often miss out on opportunities to use these products optimally.

The fact is, your medical scheme membership can be a powerful tool to help you plan for your future and to protect your health and the health of your family.

GEMS is South Africa’s largest closed medical scheme.  A core part of our mandate is to widen access to quality medical care, and a significant portion of our members have never been part of a medical scheme before.

Through working to educate our members about how to use their medical aid, we have found that there are four key factors that most members miss when it comes to using their medical scheme packages optimally.

1. Take advantage of wellness benefits

The first is understanding that often the most powerful benefits that any medical scheme provides are the ones that help prevent you from falling ill.

Do you get free wellness checks to test your blood pressure, cholesterol, blood sugar and HIV status? If so, take advantage of them. Are you covered for regular pap smears? Then go for them regularly. Does your medical scheme cover vaccinations for your children and subsidise flu vaccines? Make sure you get them done.

By using these benefits first, you reduce your chances of ending up in hospital or having to treat a more serious condition. The knock-on effect: you protect your quality of life, safeguard your future, and ultimately save the money you would otherwise have to spend if you deplete your medical savings or have to pay out of pocket for more serious medical care.

2. Understand the different options

The second thing is to properly understand the different benefit options your medical scheme offers and figure out what you really need.

Under the rules set out by the Council for Medical Schemes, all medical scheme members have baskets of basic benefits they are covered for – regardless of which medical scheme you’re with, or which option you are on. These include emergency medical conditions, more than 200 specific medical conditions and more than 20 chronic conditions.

Medical schemes build from this foundation to create different options or packages that vary in price depending on the additional benefits they offer. Go through these carefully before choosing your option to ensure you pick a package that meets your needs and the needs of your family (based on their ages and how healthy they are).

3. Use network providers

The third thing to do is to pay attention to the ways that you can save. For instance, most medical schemes have agreements with healthcare providers in their network. Using these providers will often mean that you’re fully covered and will not have to fork out extra for your treatment.

Yes, there may be times when you want to see a specialist who isn’t on the network. Save these for exceptional circumstances only.

Similarly, make sure you register for programmes that your medical scheme offers to help you save. For instance, registering for a maternity programme unlocks benefits that you can use for your treatment during pregnancy, instead of paying for treatment out of your day-to-day benefits.

4. Use generic medicines

Finally, perhaps one of the smartest ways to use your medical aid is to use generic medicines.

Generic medicines contain the same active ingredients as brand-name medicines, and are identical in strength and dosage. They work in exactly the same way as brand-name medicines. The only real difference is that they cost a fraction of the price – in some cases up to 80% less.

Ultimately, all these tips call for one thing: an investment of time and attention on your part. Considering the potential pay-off in well-being, quality of life and financial savings, it could be the most important investment you make.