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Stretch your medical cover over the year

By Andrew Edwards

28 Jan 2014

In order not to run out of medical aid benefits before year-end, follow these 10 tips and extend your medical cover.

Use generic medicines wherever possible
You can cut the amount you spend on medicines, especially chronic medication by as much as 30% by choosing generics rather than the more expensive original if your doctor approves it. Some medical schemes make it compulsory to use a generic if it is available on the market, but check with your doctor first.
Make sure your healthcare provider charges medical scheme rates
Some doctors and specialists charge more than the medical scheme rate. Shop around, as there are many doctors who agree to charge medical scheme rates. You will find doctors who are part of a medical scheme network will offer more affordable rates.
Prevention is cheaper than cure
Taking preventative measures to manage your health not only saves you money in the end, but helps saves lives too. Each year, you should plan to go for tests appropriate for your age such as cholesterol, insulin, blood pressure, mammograms or prostate checks as well as dental and eye check-ups. These types of tests can pick up serious diseases such as diabetes, cancer and heart disease early on, allowing you to manage them rather than landing up in hospital. Some schemes cover these types of tests out of the risk portion of your medical scheme contribution, meaning you do not have to use your savings account to manage your health better.
Avoid going to specialists directly
It is easy to think that only a specialist can treat you, but many conditions that are more common can be identified and treated by your GP. Avoid going directly to a more expensive specialist, unless recommended by your GP.
Keep the costs of diagnostic tests low
Few people realise how much they spend on unnecessary blood tests each year. Your GP should keep a comprehensive file of all your visits and test results and build up a holistic picture of your health over time. Avoid chopping and changing doctors if at all possible, as different doctors may order the same blood tests for the same symptoms.
Understand how your scheme works
Often medical scheme members feel baffled by the amount of information they are given about payment limits, savings accounts and in- and out-of -hospital allowances. Read all the information you can and do not be afraid to ask questions. Your financial advisor or call centre staff should be able to explain to you how much you are able to spend on different providers, such as GPs and specialists and medical procedures before having to pay out of your own pocket.
Play by the rules
An unauthorised operation or medical procedure can be expensive, so always remember to phone ahead for pre-authorisation from your scheme. Make sure your medical scheme covers emergency events, such as car accidents, automatically. When applying for medical cover, be honest about your state of health and any pre-existing conditions, or the scheme can refuse to pay for certain treatments based on your non-disclosure.
Keep a record
It is easy to lose track of which claims you have submitted and which have been refunded to you and at what rate. Keep a file detailing all claims and monthly statements. This will help you manage your medical cover better and it will help you analyse whether you need to upgrade your cover to a higher option, even if it seems more expensive. A young family, for example, may find that it's more cost effective to take out day-to-day cover that covers GP visits rather than funding those visits themselves.
Budget
While health problems are difficult to predict, it is wise to try to spread out your medical expenditure throughout the year. In winter, for example, it is more likely that you or your family will require more GP visits to treat upper respiratory infections. Plan to put extra money away each month at the beginning of the year to fund any shortfalls later on. If you require surgery, like any other service, do not be afraid to ask for a quote beforehand.
Empower yourself
People often do not question their healthcare provider and ask if a treatment or medication is necessary or negotiate a price, because they do not have the knowledge to help them make a proper decision. Educate yourself about your health, your cover and ask your financial advisor or medical scheme for information and advice. By actively managing your health and medical cover, you can make each rand go further.