SA's No 1 Insurance Blog

Recently I was asked by a client whether it would make sense for her to switch from Discovery Health to Momentum Health.

Now she and her daughter were on the Classic Comprehensive plan at a cost of R4, 828 a month.
A similar option at Momentum is their Extender Any Hospital and Any Chronic Service Provider option at a cost of R6, 064 a month.

Now that’s a large chunk of change from anyone’s pocket; so first thing I did was look at how much of the cost was going to risk benefits. And when I say risk benefits, I’m talking about anything to do with hospital.

You see, the 2015 Council of Medical Schemes annual report shows that almost 61% of healthcare costs were for in-hospital procedures. That’s according to the GTC Medical Aid Survey 2016.

Here’s how these two plans stacked up for a single member in 2016

Discovery Health Classic Comprehensive:

  • R4, 026 a month total cost
  • R3, 020 of that towards risk
  • R1, 006 to the Medical Savings Account

Momentum Extender Any Hospital Any Chronic Service Provider:

  • R4, 616 a month total cost
  • R3, 462 of that towards risk
  • R1, 154 to the Medical Savings Account

Now here’s the catch:

Who amongst us knows for sure what we’re getting for our money?
Let’s say, for arguments sake, you went into hospital for a tonsillectomy –

  • Would Momentum pay more of the hospital bill than Discovery since they were charging almost a R1, 000 a month more for the risk portion?
  • Or would Discovery Health get better rates because they’re much bigger and have more buying power?

Don’t get me wrong. I’ve been a member with both these companies, and I’ve never had any complaints. If my health was on the line, then I’d be comfortable with either of these companies.

But I did get to thinking about the small fortune each of us spends on medical aid hoping we have the best cover money can buy.

And it just so happened that I was asked to write a few articles about Fedhealth.

Now I’ve never really paid much attention to Fedhealth (or any other scheme for that matter), but when I visited their website I found a block at the bottom mentioning their unique benefits.

Curious, I clicked on the block and discovered a lot of stuff I’m not getting at my current medical aid. Here are three of their unique benefits:

Unique benefit one – Unlimited and free doctor visits if you use the network

Let me put it this way – on my current scheme, each time I see a doctor I pay.
Yes, I do get up to 6 free consultations every year at one of the network doctors, but that’s only after I’ve spent all my savings.

At Fedhealth, I can see a network doctor from day one and pay nothing, even if I see one ten times a year.

If you’ve got a big family, then how important would this be to you?

Unique benefit two – Child rates for financially dependent children up to the age of 27

So your son or daughter has just turned 21 but they’re still studying. In other words, they’re still financially dependent on you.
At my scheme the day they turn 21, I start paying adult rates regardless of whether they’re a student or not.
At Fedhealth you get to pay child rates until they turn 27.

Sound like a whole lot of nothing?

  • Take that Momentum plan we spoke about earlier. One adult and one child costs R6, 064 a month. Change that child to an adult and it jumps to R8, 299 a month – that’s R2, 235 more every month.
  • Or what about Discovery? R4, 828 a month becomes R7, 835 a month – R3, 007 more a month.

No arguing with that, is there?

Unique benefit three – Upgrades to higher options any time of the year

By now my head is swimming, “This can’t be true!
My medical aid would never allow this, and I’m the first one to tell my clients that the reason they can’t upgrade is because people abuse the system.
Think about it. You get diagnosed with some or other scary disease and the first thing you want is the best medical aid money can buy.

The guys at Fedhealth aren’t even shy to say it. Here’s what it says on their website:

“Upgrades to higher options any time of the year within 30 days of diagnosis of a dread disease or life changing event – which means you’re never locked into an option should something dramatic happen that changes your circumstances.”

This completely blows me away that they’re willing to do this. But by now I’m skeptical about the cost (just like you are, right?), so I look for a plan similar to the two mentioned above.

I find out it’s called the Maxima Exec and here’s what it costs for a main member:

  • R3, 639 a month total cost
  • R2, 924 of that towards risk
  • R715 monthly to the Medical Savings Account

Okay, their risk premium is more or less the same as those above and their savings is less. I’d suggest taking out gap cover anyway to top up the cover from 200% to 500% of the Fedhealth rate. And doctor visits are covered in full if you use one in their network.

I’ll go into all of their plans in detail on a later article.

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Until next time.

The InsuranceFundi Team