Wise up on medical aid

Johannesburg - While medical cover has become an expensive necessity for most families, most consumers do not know how to choose an affordable fund that will suit their needs.

Bongani Mncwango, CEO of Sanlam Healthcare Management, advises taking an inventory of you and your family's medical needs to make sure that your chosen fund will address them.

This includes the following steps:

• Draw up a medical profile for you and your beneficiaries. According to Mcwango, a general practitioner can assist with this, also taking into account your family history to see if you are genetically at risk of major medical conditions.
• Parents should note children are the highest claiming membership base. "Kids are prone to all serious illnesses so you need to have the best cover you can afford, at least until they turn five," said Mncwango.
• According to Mncwango, "Risk tends to increase with age so your medical aid should be adjusted as you move on through life's many stages." Middle-aged people should be looking at more comprehensive benefits, which include chronic medicine for elevated cholesterol or hypertension, among many conditions.

  The older you get, the more benefits your cover has to include (for instance glasses, and hip as well as knee replacements), he said.

• If you are married, you also have to make provision for your spouse's needs. You will need cover for confinement and possibly premature birth benefits, should you decide to start a family.
• If you are single, the assumption is that you're young and healthy. You might only need hospital cover and emergency services to cover basic and critical conditions, such as a sport injuries and hospitalisation, said Mncwango. The option you choose should not be expensive.
• It's important not to over-extend your finances, so it is advisable to draw up a budget from which a realistic amount can be allocated to medical aid contributions, said Mncwango.
• Only then should you approach a medical broker to choose a fund, advises Mncwango.
• According to Mncwango, any amount more than 15% of you income (including out of pocket co-payments) is too much to pay for medical aid. For a lower income bracket (less than R10 000 per month), hospital cover is the more affordable option. "But it is important to be realistic and acknowledge that you will get exactly what you pay for," he said.

The health market is saturated with medical schemes offering similar services. Mncwango said it's important to verify the authenticity of a medical aid.

A vital check is whether the medical scheme meets the minimum 25% reserve ratio. This is to ensure that "for every R1 000 per month contribution, R250 must be kept in the fund to ensure your medical claims can still be paid should anything happen to the scheme", said Mncwango.

- Fin24.com