Medical Aids

[Bass]

So this evening I get home to the delightful news that Penny took Lee (our daughter) to the optometrist, and the bill for R2500 will not be paid by the medical aid !! :mad:

It seems that we have used up our savings (why am I paying R4000/month ?!!) and optometry/anything else I will have to pay for from now on !! :(

It's not like we have had anything big happen too - just the normal visits to the doctor.

Anyway - do any of you have recommendations for medical aids & what packages are you on ... ?

Thanks in advance ..

[rainy]

Which one are you on? Unfortunately most of these packages that come with a Medical Savings Account work like that. Once you've used it up, the rest comes out of your own pocket. I am on Discovery Classic Saver which works exactly like that. Best idea is to keep track of your claims on a monthly basis and check what you have left.

[Bass]

I'm with Fedhealth.

What cheeses me off is that previously there were benefit limits for various categories (OHEB), but it seems like they slyly cut those down without telling one about it. This is the first time we are claiming for glasses/optometry in the last 3 years, but no - no benefit !

[rainy]

I would tell them straight out that you have never received any documentation about the change of benefits and that you're going to take your 4 large per month somewhere else. Sometimes that's the only language these people understand.

[sss]

these savings plans are a big heap of BS

[TG]

I'm on Discovery Classic Comprehensive. It's very expensive... I'm paying just over 5k for the 5 of us... BUT I've never had problems with them. They've covered just about everything I've ever thrown at them (including my sleep apnea stuff - although that gets paid out of my huge MSA). You need to avoid claiming stuff that is schedule 2 and under... rather pay for that out of your own pocket, then there's less hit on your MSA.

Each family member is covered for up to 17k dental each.

I can't go look up the rest of my benefits, as their systems are offline in that section at the moment.

[stoke]

I am on the government health scheme.

It's quite awesome:
- we get to go to the local clinic for free perscription drugs, on a certain day only, and you have to be there within the 2 hours allocated or else they send the drugs back to the hospital.
- we get to stand in massive queue's at the hospital dispensary after standing in long queues at the doctors rooms to get a perscription changed.
- we can go to the local clinic for headaches and cuts and colds and flu, and stand a good chance of receiving TB while there.
- we hope and pray that the emergency room team is not striking if somebody has a serious accident.

When I get steady income, I will buy into a hospital plan, but, that savings account rubbish is absolute trash. I prefer to pay with my own cash and, AND, AND I can negotiate the cash rate before going in to see the doctor. And, pharmacies also provide good cash rates once you get to know them, and them you.

I was on Discovery, and when I left the medical scheming thieves, they paid me R5800 back that was in my "savings account", that they kept for 4 months after the contract was closed, interest free.

I never used the "savings account", preferred to go in as a private patient. But I was forced by work to take their selected medical scheming thieves.

[senorblinky]

But how does the savings account work?
Do you save each month?
does it have a cap? (like i pay medical aid for over 100 years and never claim, but my medical savings account will never be more than R5k, comprende?)

How can i find out what i am covered for and what not?
Braces? (I've got a crooked tooth, but it's not life threatening, it's cosmetic)

??

[Bass]

i AM REALLY LEANING MORE AND MORE TO GOING ONTO A HOSPITAL PLAN ONLY ...

(ERK - CAPSLOCK - getting as bad as MMBB)

Anyways - will have a look at all the plans ...

Thanks for the feedback so far - it really helps knowing what other people's experience is .. :)

[rainy]

Hospital plan, yes. Absolutely sensical. But for now I am glad I have more than that. My recent chiropractor treatment cost me a pretty penny, and if I hadn't been able to claim it out of my MSA, I'd be much poorer now than I was before. Most doctors up here are not too keen on negotiating anyway.

---------- Post added at 06:49 PM ---------- Previous post was at 06:47 PM ----------

Blinky, you get a certain amount into your MSA every year that comes from the Medical Aid. The MSA is there to cover your day-to-day medical expenses, such as general doctor's visits, medication etc. Usually a plan like that has reasonably comprehensive emergency and hospital cover (mine does). Whatever is left at the end of the year carries over into the next.

[Voicy]

I'm on Momentum... 300% hospital cover + saving plan for GP etc.

It's only expensive until you need it.

I haven't mentioned this to you guys last year as it was a rather sensitive issue, but my mom recently donated her kidney to her very ill sister. Both are doing fantastic now, but that operation cost over R200k.

Kinda makes you think :meh:

[SintaxErr]

the MSA is essentially your money anyway. So if you have a one or not it's the same thing. Just make sure your medical covers at least 200 or 300 % of Medical aid rates as that is what most decent hospitals charge..

[Drusky]

Bass go for a hospital plan and put that 4K per month (or whatever is left after hplan) into a money market. Later you can invest part of it in a steady share and keep some capital and whatever dividends you get in the mm for immediate use. In a few years you should be pretty well set for most problemos. Hospital plan is NB, a week in intensive care can knock you for R250K quite easily.

[WondaWoman]

When I was working in insurance, they changed the whole way in which medical aids work. Before you could choose a certain amount that would go into a savings scheme for day-to-day medical expenses. Then a new law came into being in which you either have a savings plan on your medical aid or you don't. If you don't, you pay for all daily stuff outta your own pocket as a private patient.

Just keep in mind that there is a diff price scale for medical aid okes and private patients. Private patients usually get a bit of a discount and maybe even more if you pay cash right away. Medical aid rates are a bit more due to the admin involved blah blah.

So what I found the most cost effective is to save your own buck into a savings plan - which you swear on your granny you won't touch unless there is a medical emergency. This is effectively the same as a savings plan, except you can earn interest on it and the medical aid can't give your carp about how it's all of a sudden all used up.

Keep a hospital plan tho for emergencies - discovery and libertylife are pretty good. Libertylife has some pretty kief plans for those of us who earn not so much.

Also...I understand that medical insurance is making a comeback. According to my research (and i may be corrected here) you can have a medical aid AND insurance - you just can't have two medical aids or two insurance(s)?

Anyways I was phoned up by a company the other day - FirstMed or some such - who for R70 bucks a month offered me medical insurance. The oke said that the insurance would pay directly into my bank account for expenses that were incurred over above what the medical aid would be willing to pay for hospital stays etc - up to a max of R1000 per day. It sounded good, so I gave the number to my boss - I'm hoping my work will pay for the insurance part.

Enough said. Main point - drop the savings plan and save on your own. But do it for real and don't touch the savings for anything but medical expenses. It does work out in the end. Just keep a hospital plan, coz that can be a huge expense if you need big stuff done.

[Askari]

I quite like the sounds of this one: http://www.cmp.co.za/Products.aspx?itemId=3

They dont have a 300% plan but Bonitas do. Its double the price though. However that CMP seems to indicate they have negotiated rates with most hospital groups and they pay 100% of those as opposed to 100% of 'medical aid rates'

[Voicy]

I quite like the sounds of this one: http://www.cmp.co.za/Products.aspx?itemId=3

They dont have a 300% plan but Bonitas do. Its double the price though. However that CMP seems to indicate they have negotiated rates with most hospital groups and they pay 100% of those as opposed to 100% of 'medical aid rates'

Too briefly explain the % story...

You get 100-300% Standard Hospital Rates, since specialists are legally allowed to charge up to x3 the Std. Hosp. Rates. Being covered for 300% means the sneaky anesthetist can't issue you with a silly bill that you're not covered for...

Now, be very careful of places i.e. Discovery that say ever so boldly that they cover 100% Discovery Health Rates as these are not the same rates as the SHR mentioned above, but rather the rates Discovery think you SHOULD be paying.

Now there's no problem with this - IF the hospital you go to likes Discovery and accepts their payments - However (dramatic pause) more and more private practitioners refuse payment via Discovery and the patients are forced to pay out of their pockets and claim back from Discovery...

I can't quite remember the details, but I suspect if you claim back from Discovery, they only pay out their rates with the excuse that you should've gone to one of their preferred practitioners...leaving you to pay in the excess.

---------- Post added at 08:21 AM ---------- Previous post was at 08:14 AM ----------

There seems to be a new spanner in the works that will benefit Stokey and the other communists...


THE new National Health Insurance (NHI) scheme could mean higher taxes for the person in the street, and threaten the viability of both public and private healthcare, in the country.

Speaking at the Hospital Association of South Africa’s (Hasa) conference in Durban last Friday, health economist Alex van den Heever said an ANC task team was considering increasing the health budget by R100billion to fund the initiative.

Van den Heever said the proposal was that medical aid members would pay 85percent of their contributions to a global fund which would pay both public and private sector providers .

He said non-medical aid members would pay five percent of their income to the fund to make up the R100bn.

He also said medical schemes would only be able to cover benefits not covered by the NHI.

Then the private dudes clash back by saying ...


The general manager of strategy and risk management at Discovery Health, Dr Jonathan Broomberg , said in order to provide services equivalent to those currently obtained by members of medical schemes to all members of society, the NHI would require funding of about R490bn a year , which was around 21 percent of South Africa’s total Gross Domestic Product.

Broomberg said if medical aids were allowed to cover only benefits not included under the NHI it would have drastic consequences for South Africa’s overall healthcare system.

“Firstly, schemes would no longer exist, and thus the funding for almost all private hospitals and private doctors would need to come directly from people’s pockets.

“This would mean that individuals would face catastrophic medical bills without the protection that comes with medical schemes,” he said.

Broomberg said this could lead to the majority of private doctors and hospitals, as well as pharmaceutical companies, exiting from the market, and thus the possible collapse of the private healthcare system.

“This would have serious knock-on effects in terms of loss of skills from the economy, as those with skills are unlikely to remain in South Africa if they cannot provide themselves and their families with access to adequate healthcare services.”

sauce... (http://www.dispatch.co.za/article.aspx?id=321665)

[Tresbien]

ok, what I usually tell my patients is what WW so nicely spelled out. set up a debit order or similar to stop you accidentaly not paying into your own private savings account.
Discovery usually comes to the party with big stuff like transplants and major diseases, but you need to fight for every penny.

If you can put the money up front and negotiate a discount, do it. eg. C-sections cost 30% less if you pay it in advance.
Unfortunately when it comes to meds it is techmically illegal to discount medication like we used to. For meds, Dischem et al have their place. If it's a financial transaction, go to the likes of Dischem or Clicks as they are registered wholesalers and will sell you the meds at the same rate your friendly pharmacy round the corner buys it at. But you run the risk of never seeing the same person and the quality of pharmaceutical care is in some cases dubious (although it's just getting worse everywhere - hence me switching careers). If you want good sound advice from your local pharmacist who has known you since you were knee high to a grasshopper, then you may just need to pay a little more.

I can't comment on what Voicy said about the HASA congress as I don't have the reports yet.

[Voicy]

I can't comment on what Voicy said about the HASA congress as I don't have the reports yet.

Some more scandaaaaal...


The comprehensive document lists a number of services for both primary and hospital care identified as part of the package covered by the NHI.

However, it states that “it is important to emphasise here that appropriate mechanisms must be developed to ensure that there is efficient and effective delivery of the covered services”.

“This implies restricting the number of visits each covered member or household is entitled to in relation to GPs, specialists, optometrists and dentists.”

Thus, visits to a general practitioner would be limited to, for example, three visits a year for a single person, allowing additional visits only if there was a specific, clearly determined need.

Specialist consultation would be limited to referrals from GP’s, who would act as “gatekeepers”.

and then some ...


Among the proposals put forward in the document are:

lTo establish an NHI Fund, funded by monthly, obligatory, progressive contributions based on an individual’s income, and collected by the South African Revenue Service, as well as receiving funding from the general tax pool.

lTo exempt the poor, unemployed and those earning less than the tax threshold from contributions, with these members’ contributions being subsidised by the State.

lTo put all public sector employees onto the NHI scheme, by rerouting their contributions from their current medical schemes to the fund.

lTo register all eligible citizens and permanent residents and assign them to the nearest healthcare facilities, with the intention of implementing an NHI card. Initially the registration process would use the Department of Home Affairs, the workplace, the Department of Social Development and even the electoral commission.

l To establish a National Office of Standards Compliance, to ensure that all healthcare facilities were licensed and accredited.

lTo address chronic staff shortages within the public healthcare sector through initiatives such as reviving the Cuban doctor programme and allowing legal foreign nationals to practise in South Africa.

lTo expand and rehabilitate the entire healthcare system by auditing both private and public service providers to assess current capacity and identify gaps for expansion.

lTo remove tax breaks for members of medical aid schemes, freeing up general tax which could then be rerouted back into the health sector. In 2005 this was estimated as costing R10.1 billion .

The policy document also calls for the establishment of an NHI Authority, accountable to the health ministry, which would ultimately be responsible for running the NHI.

Sauce... (http://www.dispatch.co.za/article.aspx?id=321936)

[Ga5can]

I like this statement ...

To exempt the poor, unemployed and those earning less than the tax threshold from contributions, with these members’ contributions being subsidised by the State.

And where does the state "earn" their well deserved cash to subsidise?

[Vortex]

I like this statement ...

To exempt the poor, unemployed and those earning less than the tax threshold from contributions, with these members’ contributions being subsidised by the State.

And where does the state "earn" their well deserved cash to subsidise?

From the 5 million tax payers..

[Voicy]

Gassie, we're in for some VERY interesting times ahead...

When I was at a conference at the CTICC in Cape Town last month the private medical reps nearly lynch mobbed the frail white boy giving his keynote address on the NHI plan. His answer to the question put forward by them "Have you taken into consideration what drastic effect this will have on private medical aid schemes and healthcare professionals?" his answer quite simply was "We're not here to make a few people rich."

1st I was like :eek:

Then I was like :blink:

---------- Post added at 11:01 AM ---------- Previous post was at 10:57 AM ----------


I like this statement ...

To exempt the poor, unemployed and those earning less than the tax threshold from contributions, with these members’ contributions being subsidised by the State.

And where does the state "earn" their well deserved cash to subsidise?


From the 5 million tax payers..

I like this line:

"lTo remove tax breaks for members of medical aid schemes, freeing up general tax which could then be rerouted back into the health sector. In 2005 this was estimated as costing R10.1 billion ."

Who can smell the bananas?

[Tresbien]

Eish, I am speechless ...

[Stool]

Tres stop stuffing around and give us notes on how to setup our own drip bags including getting the needle in the arm :D. I so need this information today. I keep dehydrating whilst sleeping

[stoke]

Try eating fruit and other substances with liquid in them.

[WingNut]

I keep dehydrating whilst sleeping

Stop wetting the bed. :D
And playing with matches before going to bed.

[Tresbien]

:rofl: the mental images, oh dear.

Stool, Shamus would be better able to help you there boet. I could just help you make up the drip bag. He'd be the one sticking the needles in people. :D

If you want to make your own rehydration solution get a litre of warm water, dissolve 8 Tspoons of sugar and one of salt into it. Add some orange juice for flavour. Drink and enjoy!
Or you could go onto PnP home shopping/Mr Delivery and order some coke, make it flat and drink that rather. :)

[sss]

i thought coke dehydrates you

[Drusky]

Yes, caffeine makes you go wee.

[Arbythep00nage]

Hospital plans are the way forward. The savings things are stupid cos you pay for everythign at the end of the day and pay at a higher rate anyways.

[Stool]

coke is mostly done to replace sugars

You know how they always say in the hospital that the patient will make a speedy recovery? Well its because they on a drip. Tres I cant drink in my sleep. Do pharmacies sell drip bags?

I'm at the point of joining some part time nursing school. Next time I'm out of commision it will be in luxury.

[Bass]

Thanks for the feedback guys (& gals :D) ... We've been looking at all the options and so far can unequivocally say the FedHealth is a BAD option generally. The other medical aids generally have much better benefits for roughly the same amount.

Am seriously looking at all the hospital plans now ...