YEARS ago, choosing a medical aid wasn’t something you had to worry about — your employer simply chose for you.
These days, however, there are a plethora of schemes to choose from, and it can be an overwhelming process.
Choosing medical scheme cover is a balancing act between what you can afford and your family’s healthcare needs, bearing in mind that these needs change over time. You also have to ensure that you choose a scheme that will be around for some time — it should be financially secure and sustainable, and have a strong record in terms of member service levels.
Andrew Edwards, executive principal officer at Medical Scheme (LMS), says: “Choosing the right medical scheme is a difficult, yet important choice for any member to make. To assist in this decision, we offer the added benefit of financial advisers who will be able to explain and assist members with the correct choice of plan or cover, enabling members to make informed decisions about the right medical plan, thereby allowing them to own their health.”
LMS advises that since members are only permitted to change options in January each year, they should review their benefit option towards the end of every year to ensure that their family has adequate cover in the following year.
“This is especially important as members move through different life stages from early adulthood, getting married, planning a family, growing older and retirement,” says Edwards.
When choosing your cover for the year, there are a number of things you need to consider. For example, ensure that you have comprehensive major medical cover in the event of a catastrophe, such as a motor vehicle accident or a traumatic crime incident. Older members are more likely to need out-of- hospital cover for chronic medical conditions such as diabetes, high blood pressure and high cholesterol. Mothers and young children have specific needs in terms of maternity cover and require comprehensive cover for day-to-day expenses.
Some other groups of members with special needs include professional athletes, members who travel overseas often , and members at high risk for specific diseases. Of course, the principal member will need to consider the needs of all the members in their family and ensure that they have cover.
Edwards says that medical scheme members want to know that comprehensive benefits are going to be accessible as and when they need them. To this end, LMS benefits are designed to provide meaningful cover according to recognised treatment protocols.
“By making healthcare provision simple and transparent, our members’ expectations are regularly exceeded,” he says . “In addition, our informative website and marketing materials make for transparency of information, and complexity is made easy to understand.”
LMS differentiates itself from the cluttered and often confusing marketplace with its unique approach of ensuring that cost-effective and appropriate healthcare is available to all. LMS goes further still by offering benefits that are unique to LMS, including crime trauma benefits, casualty benefits as well as numerous preventive care benefits paid by the scheme rather than from your savings. And unlike other medical schemes, LMS will cover members in the event of an injury due to participation in professional or hazardous sports and pursuits, such as bungee jumping, motor racing, parachuting and mountain climbing.
South African medical schemes legislation prescribes a minimum level of cover for all members, and LMS offers its members a variety of options within this legislative framework.
“We cater for different pockets and healthcare needs, with the aim of giving members the cover that they need at prices that they can afford.
“By carefully analysing the market and providing targeted solutions aligned with different member needs, we believe that we will achieve optimum member satisfaction and retention,” says Edwards. “Our large membership base enables us to offer this flexibility to members while still maintaining adequate pooling of risk.”
LMS believes that it is in the interests of all its members to be educated and empowered to make better and healthier lifestyle choices, as this affects their individual healthcare needs as well as their scheme’s financial health and the cost of their healthcare cover.
“Preventative care helps keep members healthy by ensuring early identification and treatment of any health problems,” says Edwards. “Our benefit options therefore include generous preventative care cover, including cover for a range of age-appropriate health screening tests and vaccinations for children. We also have a variety of disease management programmes that cater for members with specific conditions, providing individuals with comprehensive information and assistance related to the ongoing management of their condition.
“Consumers need to feel that they have control over complex buying processes, such as selecting a medical aid. And they are looking for a medical aid that empowers them to make their own informed choices, but with the confidence that they can access appropriate financial advice from their medical aid if needed.
“LMS enables members to make confident decisions that are best for them and their families, following our value proposition of allowing members to decide for themselves.”
So, the experts advise that when looking for a medical scheme, you should look for one that is focused on its members’ health and wellbeing; one that will help you to own your life and health, and be involved in important decisions that affect your own health as well as that of your family.