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Medical Aid Company news South Africa

Medical aid cover for durable medical equipment and assistive devices, by Medshield

Life is unpredictable. An unexpected circumstance can lead one to depend on durable medical equipment (DME) and assistive devices to maintain independence and improve quality of life. DME refers to equipment and devices prescribed by healthcare professionals for medical purposes, such as wheelchairs, walkers, hospital beds, and oxygen equipment. On the other hand, assistive devices are designed to help people with disabilities complete daily tasks, such as hearing aids, prosthetic limbs, communication devices, and computer accessories with adaptive features.
Medical aid cover for durable medical equipment and assistive devices, by Medshield

However, obtaining these essential tools can be prohibitively expensive, making comprehensive medical aid cover crucial. It is more than just financial assistance; it is about enabling people to live their lives to the fullest despite physical limitations.

Let's look at why having this cover isn't just beneficial but necessary for consumers:

    1. Promoting independence and dignity

    Independence is crucial for human dignity, but individuals with disabilities or chronic conditions may become dependent on others without the necessary tools. Medical aid cover helps them regain independence by providing tools like stair lifts and mobility aids, which increase independence and preserve dignity. These devices help people navigate the world on their own terms.

    2. Improving quality of life

    DME and assistive devices significantly impact emotional well-being, quality of life, and physical benefits. They can transform lives by providing new opportunities and experiences. Medical schemes promote members' overall well-being by including cover for such equipment, leading to a healthier and happier society. Examples include a child hearing their parent's voice or a stroke survivor regaining mobility.

    3. Long-term cost savings

    Cover for DME and assistive devices can provide long-term cost savings by preventing complications and hospitalisations due to unmanaged conditions. It allows timely access to necessary equipment, such as continuous glucose monitors, to help diabetic patients manage their condition better. Investing in preventive care through comprehensive medical aid cover results in savings for individuals and healthcare systems.

    4. Ensure equity and inclusion

    Healthcare access should be a fundamental right, regardless of socioeconomic status or personal situation. However, inadequate cover for DME and assistive devices disproportionately affects marginalised communities. Medical schemes can promote equity and inclusion by including these critical tools in their offerings, benefiting individuals and creating a more just and compassionate society.

What to look for in your benefit package

Medshield Medical Scheme covers various DME and assistive devices*, helping members manage their health and improve their quality of life. Members can receive financial assistance for prescribed DME and assistive devices through the scheme's benefits package, subject to specific terms and conditions. Outpatient or chronic illness benefits typically cover DME and assistive devices, and members may need a prescription or recommendation from their healthcare provider.

Cover can vary depending on the type of device required, the medical necessity determined by a healthcare provider, the member's diagnosis or condition, and any applicable waiting periods or pre-authorisation requirements. Reviewing your plan documents or contacting your medical scheme directly to understand the specific cover details and limitations is critical.

Medshield encourages its members to become familiar with their plan's DME and assistive device cover, including any co-payments, deductibles, or cover limits. Members can maximise cover and reduce out-of-pocket costs by understanding their benefits and working with Medshield-contracted healthcare providers and suppliers.

To maximise your cover for DME and assistive devices, consider the following quick tips:

  • Know your benefits: Learn about your medical aid plan's cover and the scheme rules for DME and assistive devices, including co-payments, deductibles, or cover limits.
  • Obtain necessary documentation: Ensure you have a prescription or recommendation from your healthcare provider for the required DME or assistive device. This documentation may be required to qualify for cover.
  • Research providers: Work with medical aid scheme-contracted healthcare providers, suppliers, or vendors to ensure maximum cover and minimise out-of-pocket expenses.
  • Understand the authorisation process: Know any pre-authorisation requirements or documentation required to obtain cover for DME and assistive devices. It may involve filling out forms or providing additional medical information.
  • Investigate alternative funding options: If medical aid cover is insufficient or unavailable, consider alternative funding sources such as government assistance programmes, charitable organisations, or crowdfunding platforms.

It's worth noting that cover for specific devices may differ depending on medical necessity, plan benefits, your medical scheme rules and provider agreements.

Access to durable medical equipment and assistive devices is crucial for people with disabilities or medical conditions to maintain independence and improve their quality of life. Medical aid schemes provide financial assistance for these essential items. To maximise cover, understand your plan's benefits, obtain necessary documentation, and explore alternative funding options.

Consult your medical aid provider for personalised advice and assistance. Medical aid cover promotes independence, dignity, and quality of life for all individuals, empowering them to live on their terms.

*Depending on your selected benefit option, clinical protocols and scheme rules apply.

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