It’s that time of year when you may be considering changing your medical scheme. Liberty Medical Scheme’s Executive Principal Officer, Andrew Edwards, outlines the key questions you should be asking. 

What’s the most comprehensive cover I can afford?

Many people choose the most basic benefit plan because they don’t anticipate that they will fall seriously ill, especially if they are young and fit.

The majority of these basic benefit plans have limited major medical cover. 

A major medical event, such as a car accident or the birth of a premature baby occurs unexpectedly, requiring immediate hospitalisation.

Without major medical cover, you will have to fund these medical costs from your own pocket.

Ask your financial adviser about the benefits of each scheme and the option that best suits your needs.

Which option plan is suitable for my life stage and health profile?

Whether you’re young and single, starting out or already have a young family, choose cover best suited to your stage in life.

Don’t leave signing up for medical cover until you really need it as you may face waiting periods or exclusions. Upgrade your option in advance of planning to start your family as there can be exclusions for maternity benefits if you sign up too late.

Chronic conditions, such as diabetes, cancer or depression can strike at any time (especially when you have a family history), so find out what disease management programmes the scheme offers should you develop one of these.

What benefits are funded from your medical savings account?

Don’t simply compare medical schemes in terms of the rand amount in your medical savings account or think that bigger is better.

Check to see whether your scheme pays for benefits such as preventative tests and scans from Major Medical Benefits (MMBs) rather than your medical savings account.

Through its Extender Benefits, most of Liberty Medical Scheme options cover a variety of essential day-to-day costs from MMBs without depleting members’ savings.

These benefits include preventative care, such as child immunisations, casualty, crime trauma and even out-of-hospital scans on most options.

Also ask about the availability of an Above Threshold Benefit which allows for more complete cover. This is a safety net that provides cover for your day-to-day expenses once your medical savings account has been depleted and your total day-to-day claims reach a pre-determined threshold level.

Does the scheme provide a network of doctors or hospitals?

Schemes which have access to networks of doctors or hospitals are often able to offer more affordable medical cover that may better suit your pocket.

Rather than view this as limiting your choice, look at it as saving you money while offering the best quality of care. Check what healthcare providers and facilities in your area are signed up with the particular medical scheme you are considering.

What rate does the scheme pay GPs, specialists, hospitals and other healthcare providers?

Some providers charge above medical scheme rates, which means you will have to fund the difference from your own pocket. What benefits does the scheme cover in and out of hospital?

Many schemes require members to provide a co-payment for particular procedures and treatments. Find out whether your scheme funds providers at 100% or 200% of the medical scheme rate.  Liberty Medical Scheme pays between 200% and 300% on certain options for GPs and Specialists.

Does the scheme offer rewards?

The bottom line is that rewards programmes shouldn’t be the main reason why you choose a particular medical scheme. It’s the quality of the medical cover that you are purchasing that you should focus on.  Don’t get distracted by nice-to-have memberships and discounts.

How effectively does the scheme manage its administration?

You want to make sure your claims are processed and paid as conveniently and quickly as possible.  Look for services such as being able to download your statements, as well as submit and track your claims online.

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