Just because you are young does not mean you are insusceptible to chronic conditions and dread diseases.
Adding to this; accidents happen when you least expect them. There is a perception that if you are young, you don’t need medical cover, but that is far from the uncomfortable truth.
Technology has us leading increasingly sedentary lifestyles, which can lead to conditions such as hypertension and diabetes.
If you are without cover, medical costs associated with hospitalisation, surgery, therapy, consultations and medication can entrench you in debt. There are also costly penalties applied if you have been without cover for 90 days or more or if you are over 35 years old and have never belonged to a medical scheme before.
There is a portfolio of products for young South Africans with varying budgets and health care requirements, popular among these are the income-based plans and hospital plans.
An income-based medical plan charges a premium based on your monthly salary. If you are in in the low- to mid-income bracket seeking some basic cover then this is an ideal solution for you, provided that you are willing to use designated service providers only.
As well as being affordable, income-based plans typically offer unlimited benefits in hospital, usually at 100% of the scheme rate. Because tariffs are pre-negotiated, co-payments do not apply in most options, provided you use network providers.
In addition, income-based plans typically provide limited cover for clearly defined out-of-hospital expenses, such as consultations with network GPs, prescribed medicines, and general radiology and pathology. They can also provide limited maternity cover, making them suitable for young South Africans who are planning families.
These hybrid medical products set aside a percentage of your total annual contributions in a savings account to be used to cover day-to-day expenses. Once you’ve exhausted your annual savings, you have to pay for GP and specialists visits, as well as medication, out of your own pocket.
Hospital plans cover the costs of procedures, consultations and medication provided in hospital when you are admitted. They also usually provide benefits for radiology and pathology, oncology, dialysis and internal prostheses, such as pacemakers. (Don’t be fooled into thinking this is only something that old people need)
More expensive hospital plans provide benefits at any private hospital or clinic, while budget options usually cover costs only at state hospitals or specifically designated private facilities.
Upgrading your plan
Regardless of the type of medical plan you choose, you have the choice to upgrade to a more comprehensive product, as and when your circumstances change. For instance, if you’re diagnosed with a dread disease that requires sustained medical intervention out of hospital or you’re ready to start a family, you can level up to a product that offers the higher level of benefits that suits your particular situation.
In most cases though, you may only be allowed to upgrade at certain times of the year, and a pre-existing condition may be temporarily excluded from the cover.
It is extremely important that you understand the terms and conditions of the scheme that you are on as these change from year to year. Even the terminology in this blog may be subject to changes without notice!
If you’re unsure what you are currently covered for or if you are new to medical cover then let’s get in touch!