Get the right medical scheme for your age
JOHANNESBURG – Does your medical scheme benefit option match the needs of your age group?
While some health conditions strike out of the blue, there are some health problems that arise as a result of age.
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Principal officer of Resolution Health Medical Scheme, Mark Arnold said it was wise to factor in age when making a decision on which medical scheme benefit option to choose and which one would best meet your needs.
Arnold stated, “There are so many health events that we cannot predict, but certain conditions are definitely more prevalent in particular age groups. For example, data from our membership indicates that the average age for claims on orthopaedic surgery on hips, knees and spinal procedures is 51 to 52 years old.”
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Some medical schemes have agreements with certain healthcare provider networks which require that members, or members on a particular benefit option, have planned procedures in a network hospital. People often overlook this when choosing their benefit option, but when faced with the need for surgery, they want to go to the doctor and hospital of their choice. If these are not within the preferred provider network, however, the member could face a hefty co-payment, according to Arnold.
Once a year, members are given the opportunity to review their level of healthcare cover for the next year. “During this time of year, medical scheme members should consider not only their present state of health, but also take into account the types of age-related and hereditary conditions that may present themselves,” Arnold advised.
He expressed that while many people looked for ways of economising and saving money as they approached retirement, his company advised members to think long and hard before compromising on their healthcare cover. As people age, their healthcare needs tend to grow, and it is therefore advisable to increase or maintain your level of healthcare cover as you get older, he added.
By law, medical schemes must operate as not-for-profit entities, act in the best interests of their members and provide comprehensive cover for 271 of the most common and serious medical conditions through prescribed minimum benefits.
“Prescribed minimum benefits payments are funded by the main risk pool of a medical scheme, and therefore are available on all benefit options, but it is important to bear in mind that the degree of cover provided may differ considerably if the member does not seek treatment through a preferred healthcare provider, if this is a stipulation of your benefit option,” Arnold concluded.
