Do you know what your medical aid does not cover?
Needless to say, Zana wasn’t exactly impressed when she got a medical bill, including the partial expenses of the anaesthetist, gyneacologist and paediatrician, not to mention her two day stay in hospital for the birth of her second child (as if diapers, bottles and day care isn’t costly enough). It was only then that Zana discovered that, while she is on a comprehensive medical aid, the medical aid only pays 200% of the National Health Rates while the medical specialists that she used, and the hospital that she was admitted to, charged 300% of these rates. This meant that while she and her hubby were now the proud parents of their first son, they had to fork out an extra R10 000 in medical fees.
Zana will never make the mistake of assuming that she has full cover ever again. Instead, she will keep in contact with her medical aid provider to confirm what medical treatments and services they do cover and to what extend it is covered.
It’s worth chatting to your medical aid provider as well as many have a network of medical specialists and hospitals that they cover in full (depending on your medical aid plan of course).
Your medical aid provider will also be able to tell you which procedures and treatments they cover and how much cover you are entitled to based on your specific medical aid plan.
It will prove helpful to ask them about the following:
- What emergency cover you have (while you’re at it, find out what they advise you to do in the event of an emergency to save lives and costs)
- The extent of your hospitalisation cover (do they have a preferred hospital network that they cover in full etc.)
- Do they cover all visits to medical specialists or only some (find out which ones they cover in full and which they will partially cover; also do they have a list of preferred medical practitioners)
- Is medication covered by your medical plan (ask that they explain which medications are coved, if any)
- What about medical screenings, blood tests and vaccinations?
- To what extent do they cover external medical items, like glasses or braces
- What coverage have you got in the event of a trauma (can you go see a professional counsellor and, if so, how much are you covered for
- Do they offer international travel medical insurance (and how does this work)?
Based on how your medical aid provider answers these questions, you might decide that you need a little extra cover (and peace of mind). If that’s the case, it’s worth consider medical gap insurance to cover all the extra bits that your medical aid plan does not.