This is a small Likemoney guide on how to keep your medical aid scheme costs down.
You need to understand what you are covered for, at what rates and with which providers. Does your plan cover you at the medical aid scheme rate or at a higher rate? Does your plan require you to make use of a hospital or pharmacy network of doctors? Refer to the material you get from your medical scheme, use their website and talk to your financial adviser about what you are covered for.
We are often embarrassed to discuss money with our healthcare provider, but when you make the appointment, ask what rates your doctor charges and whether or not you will be liable for any co-payments. This way, you can make informed decisions about how you are spending your healthcare funds. If affordability is your biggest concern, it might be better to shop around for a provider who charges medical scheme rates, but if choice is more important to you that cost and you are happy to pay more, you will know up-front exactly how much.
Most medical schemes have network arrangements in place with healthcare professionals. By using this network, the scheme pays the professional directly, reducing administrative hassle and keeping costs down for you. Day1 Health, for example, has an extensive GP network where members are covered in full for GP consultations.
In terms of chronic illness and medicine, schemes often have formularies i.e. lists of medicine that are covered in full by the scheme. Check with your GP or pharmacist if your prescribed medicine is covered in full, and ask about alternatives if not.