Four questions to ask your financial adviser about medical aids

Published Nov 15, 2023


Deciding whether to prioritise price, needs, or benefit richness when it comes to choosing a medical aid plan is a complex task.

Your choice will ultimately determine if you have the right cover when you need to consult a doctor or specialist, need medicine, go to hospital, get spectacles, or visit the dentist.

Involving a financial adviser can make the process more manageable and help ensure that you select a plan that is right for your individual circumstances.

However, an informed choice about your medical aid is a joint responsibility between you and your adviser. While advisers can provide you with information and guidance, you need to actively participate in the decision-making process as the plan must ultimately work for you and the access you need to healthcare.

To help you find a plan that meets your requirements, ask your financial adviser the following four questions:

#1: Does my medical history or the fact that I have not been a member of a medical aid affect my choice?

The Council for Medical Schemes stipulates that medical schemes can impose waiting periods and late-joiner penalties in certain cases. Waiting periods are usually applied when you haven’t belonged to a medical aid for 90 days or longer, or if you plan any procedures, suffer from chronic conditions, or are pregnant.

Late-joiner penalties are imposed if you haven’t been a member of a medical aid for specific periods of time. These penalties are part of your contributions for life and do not expire over time.

#2: Will I be covered if I am in an accident?

Many people are concerned about what will happen if they are, for example, in a car accident and need urgent medical attention. Ask your adviser which plans cover these types of events and how exactly the process works should you need urgent care. For example, does the medical aid plan include transport to a hospital and is the cost of the emergency room covered?

#3: What are out-of-hospital benefits and why are they important?

Out-of-hospital benefits, also known as day-to-day benefits, usually cover things like doctors’ consultations, prescribed and over-the-counter medicine, and visits to the dentist and optometrist. The number of visits allowed or the maximum amount paid for these services differ from scheme to scheme and plan to plan. Ask your adviser to explain out-of-hospital benefits in detail to avoid misunderstandings and dissatisfaction later on.

It is also important to familiarise yourself with “pooled benefits”, where several benefits are covered from a limited benefit or when benefits are paid from you medical savings account. Discuss the option to add gap cover to your medical aid choice to avoid unexpected shortfalls on claims.

#4: How will you support me when I need to claim or have questions?

After-sales service is an important part of the relationship between you and the adviser. It is vital to ask your financial adviser in what way they will support you in the event of a claim or changes to plans and benefits. It is also important to gauge whether the adviser knows the various products available in the market, as well as the benefits and exclusions of medical aid plans, and can advise you accordingly based on your requirements and health profile.

Asking these four questions will help you make an informed decision about the cover you need and the process a lot less overwhelming.

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