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SA's No 1 Insurance Blog

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With money as tight as it is nowadays, who can blame anyone for looking for a better deal, right? And as much as we might not like to admit it, when it comes to our personal insurances, we are always looking for a better deal. It stems from not truly knowing if we have the best deal to begin with. If you are on a medical aid at the moment, you might want to continue reading this article. Turns out, you could be saving yourself hundreds of Rands, every month.

What is a networked medical aid plan anyway?

If you belong to a medical aid you are entitled to visit a hospital, if you require treatment (that is the whole point of paying your premiums). The only difference with a networked hospital plan is that instead of having the luxury of being able to visit any private hospital, you are limited to hospitals in a specific network.

But, if you had the choice of going to any hospital, why would you opt for a plan that has limited choice? It doesn’t make sense.

Actually, it does make sense if the networked hospital option is substantially cheaper.

In order to make their plans more affordable (and more appealing), medical schemes have started introducing “networked hospital” options to their product range.

From the scheme’s perspective, the thinking is pretty simple: If a member is prepared to choose one hospital provider rather than having the choice of any hospital provider, then we can substantially reduce the premium we need to charge them.

Now, as a consumer you are starting to think, should I be looking at an option like this?

Here are the questions you need to be asking yourself before going the networked hospital plan route:-

  • Is the hospital, I want to network myself to, in close proximity to where I live?

This is critical. It doesn’t help networking yourself to a hospital (for a saving) if the hospital is miles and miles away from you. Would you be prepared to trek 80km just to get medical assistance?

  • Am I able to pay the co-payment if I decide to use another hospital?

It’s important to note that if you are on the networked hospital option and decide to use a hospital outside of the network (emergencies excluded) then you will be liable for a co-payment of a few thousand Rand. The reason why the schemes impose the co-payment is simply because they have given you a discount on the premium and because you haven’t kept up your end of the bargain by using the hospital you networked yourself to, you are liable to pay a penalty. This can become a problem when a specialist, you want to see, only works out of a specific hospital and you are networked to another.

  • Are you comfortable with the hospital choices?

Are you 100% confident in the hospital you are networking yourself to? If we are being 100% honest, even some of the private hospitals in this country have taken a few steps backwards and it might well be that the only viable option, on the network, is a hospital you just aren’t comfortable being restricted to.

With anything in life, there are always pros and cons to every decision we make. Deciding to network yourself to a hospital, for a discounted premium, has its own set up questions you will need to ask yourself, before coming to a proper conclusion. The good news, however, is that the option does exist, so at the very least, make sure you check it out.

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Until next time.

The InsuranceFundi Team


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