Medical cover: a lifeline in times of need

Medical cover is one of those things that nobody enjoys paying for especially when they are well. We would all rather spend the money on a gift for the family or put it towards a holiday. Just how necessary is it to have medical scheme benefits? Could we do without them or are they a necessity.

Mr Steve Roux, a Trustee at the Government Employees Medical Scheme (GEMS), says that for many people medical scheme benefits are a “grudge purchase”. He points out that while this outlook is understandable, it is also important for people to appreciate that medical scheme benefits are a form of insurance when it comes to your health, and there is little that is more important than good health. Healthcare cover is therefore potentially one of the most important purchases you will ever make in your life.

Everyone needs medical cover

“The reality is that the cost of healthcare continues to rise sharply in SA and those who are not covered by a medical scheme may struggle to afford medical care if something goes wrong with their health,” suggests Roux. “Unfortunately people do have accidents and get ill, even healthy young individuals. Without doubt, everyone needs some form of medical cover to protect them in such an eventuality.”

Roux points out that it costs about R340 just to see a doctor and get medicine for flu. A private hospital stay costs R4 300 per day and a day in intensive care about R8 186. Having a baby is also expensive and can cost anywhere between R17 000 and R26 000. “It is no exaggeration to say that getting sick or needing medical treatment over any length of time can involve catastrophic or potentially crippling costs,” observes Roux.

“So often people complain that they are not getting full value from their medical scheme. While value is understandably important, and something that a good medical scheme should certainly ensure where possible, it is also a mistake for scheme members to feel that they should be getting everything out of their scheme that they possibly can. A medical scheme such as GEMS is owned and funded by members themselves. Those who use their benefits prudently, effectively protects their scheme assets as well as those of fellow members.”

Choose a scheme that's right for you

“If you consider just how important medical cover is, you can see just how necessary it is to choose a scheme and a set of benefits that are right for you and your family,” notes Roux. “This will ensure that you get the best possible value from your medical scheme.”

The first consideration for most people is affordability and no one should be purchasing benefits that they are not able to afford. However, you need to keep in mind that you get more comprehensive cover on the more expensive options.

“You should also consider the make up, age and health status of your family when choosing an option,” says Roux. “So, for example, if you are a single healthy young individual you may want a plan that is more affordable but offers good solid benefits. On the other hand, a family with young children who might have greater medical needs may wish to choose a more comprehensive cover. One has to balance affordability with one’s healthcare needs.”

“One of the things that is so appealing about a scheme such as GEMS, which is designed specifically for public service employees, is that it takes the members’ healthcare rand so much further. We don’t offer the extras, such as loyalty clubs, which are so common at other schemes today and ultimately contribute to making benefits more expensive. We stick to the basics of healthcare funding using our substantial size to leverage good rates with healthcare service providers such as doctors and dentists.”

“We furthermore ensure that the Scheme is soundly run by adhering to strict corporate governance principles and maintaining a balanced Board that has both Scheme and member-elected Trustees. As a result, all five of our benefit options offer outstanding value and public servants need look no further than GEMS for healthcare cover that will act as a much needed lifeline in times of need.”

According to Roux the five benefit options on offer from GEMS offer something for every public service employee, from those who wish to have more basic cover to those seeking more comprehensive options. “We cover day-to-day as well as in-hospital expenses,” he notes. “Members of GEMS can therefore have complete peace of mind that their every healthcare needs will be taken care of.”

“Medical schemes can offer an invaluable lifeline in times of need,” concludes Roux. “Without doubt everyone needs a good, reliable medical scheme  – not only in the event of a ‘rainy day’ but also to ensure on-going good health and longevity for those that are near and dear.”   

(Press release, GEMS, September 2011)