Time to top-up your medical aid !

In a recent blog post I highlighted the need for medical aid top up cover. Let me tell you that I’ve been blown away by the response the article generated! It’s been overwhelming and I’ve come to the following conclusion: There is obviously a growing need for good information on this subject matter and I need to knuckle down and start writing more blog posts. It’s 06H.30 on a cold Highveld winter’s morning, I’ve got my coffee and I’m sticking to my  guns (my hands are so cold, I might need to type this blog post out with my toes. So excuse any typos in the copy, I’m not yet a toe typing expert.)

So why the need for a medical aid top-up cover product? It’s really simple. Medical aids are covering less and less of the costs associated with in-hospital procedures. Medical aid premiums are going up each year but the benefits aren’t. Actually in some instances, the benefits are being reduced. That means you and I (the medical aid members) are starting to pick up more and more of the in-hospital bills that our medical aids aren’t prepared to settle in full. I’m afraid to say that this trend is set to continue and actually get worse in years to come as the cost of private healthcare keeps sky rocketing.

You see, medical aids use the National Health Reference Price List (NHRPL) when setting their rates of cover. This price list is issued by the Council for Medical Schemes who govern medical aid schemes in South Africa. This tariff rate, once set by the medical aid, will be used by them to determine how much of the in-hospital bill they are prepared to pay. The problem of course is that many medical practitioners charge in excess of the tariff rates set by the medical aid companies (BMW re-payments and holiday homes in Hermanus don’t come cheap). This overcharging by medical practitioners and the medical aids reluctance to pay these bills in full leads to a shortfall in your cover. That is problematic.

Enter the savor of the day: A medical aid top-up or gap-cover policy. No prizes for guessing how the product works. Yip, you’ve got it, it covers the shortfall between what is charged by medical practitioners and what your medical aid company is prepared to pay. The top up policy only picks up the costs associated with in-hospital procedures and not your day-to-day medical expenses, but that’s fine because let’s be perfectly honest, it’s the in-hospital procedures bills that are the heavies and not your flu medication.

Now that you know you need a medical aid top up policy, which is the right product for you?

This is a good question and these are the questions you need to ask yourself.

1)      At what tariff rate does my medical aid cover me at?

2)      Do I have an unlimited hospital benefit or is it capped ?

3)      What sub limit benefits do I have on my cover?

Now you need to get in touch with us. Click here and re-direct to our capture form. Provide us with a few details and we will be in touch soonest. We also welcome your comments, so feel free to write down your views below. Look out for my next post when I will look more closely at a top-up product for those of you with a capped hospital benefit.

Until Next Time


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