Think about a medical worst-case scenario. You’re trapped under a truck, your head is bleeding and you are sure your leg is broken in at least one place. There are sirens, ambulances, the fire brigade, and the last thing you remember before waking up in the ICU is being put on a stretcher.
This type of accident scenario is what most people think of when they think of reasons why a medical scheme is necessary. And let’s face it, under these circumstances, good medical care could save your life.
And yes, medical schemes and hospital plans are expensive, but it might be even more expensive not having one.
But being well cared for after accidents is not the only reason why having a medical scheme is important. Here are some others.
The end-of-the month flu bout. It’s three days to payday and you’re down to your last R20. You’re going to be living on potatoes and the smell of an oil rag for the next 72 hours. And then you get ill. Very ill. Your chest is rattling, your head is so sore it feels like it wants to part company with your body, and you have forgotten what it is like to breathe through your nose. And your doctor works on a cash-basis only. Except if the account is sent directly to your medical scheme. Need I say more?
Sudden expensive medication. For the same flu bout, you need medication from the chemist – and it doesn’t come cheap. In fact, even with opting for the generics, the total bill for this comes to R237,11. And right now, you just don’t have it. But fortunately your chemist sends the bill to your medical scheme and you end up having to pay a levy of a few rand. Now that you can do.
Serious diseases. Cancer, emphysema, diabetes complications, ongoing heart problems – these are things no one ever thinks will happen to them. But when they do, and the onset could be sudden, the cost of things like scans, X-rays, pathology tests, ultrasounds could run into thousands. Not to speak of lengthy hospitalisation and expensive operations. And few people have that kind of money lying around. Most medical schemes and hospital plans will cover these things in full.
The young and the old. Few people use their medical schemes much when they are in their twenties, or even thirties. But their contributions make a big difference to funding the medical costs of the older members. And young people get older, and one day their costs will be funded by new and incoming younger members. And no, it is not a solution to join when you retire, as your premiums will be much higher than those of someone who has been a member for twenty years. This is understandable. And a medical scheme is essential for retired people – this is probably going to be when you need it most.
Eye problems. Welcome to your forties. Here is your complimentary pair of reading glasses. Not really, but you get the picture. Few people get past middle age without some vision problems. These can range from minor to serious – and prescription lenses (even with cheaper frames) don’t come cheap. And you might need new ones every two years.
Not state-of-the-art hospitals. While there are some state hospitals that are fine, in fact, downright fantastic, there are major funding and staffing problems in many of them. In several of the hospitals the actual operations performed are excellent, but the problems come in with post-operative care of patients. While not all private hospitals are completely fantastic, the level of care you receive and the facilities available to you are likely to be better. And so it should be, because most of them are jolly expensive. If your life is hanging by a thread, the last thing you feel like dealing with are no sheets on the bed or dirty toilets. Or waiting endlessly in a queue while you are bleeding. So pay your medical scheme contribution with a smile.
Peace of mind. We spend an inordinate amount of our time worrying about money. If you have a family, and are a wage earner, unless you have won the lottery, you would not be able to foot the bill if your family of five were in the same car accident and all landed in hospital. Whereas medical schemes do have limits, most hospital costs are at least paid for. So now you can sleep at night.
Ambulances. If you’ve had a heart attack and are lying on the floor of a restaurant, you want the ambulance to get there without delay. Sometimes state ambulances are very swift, but there are also horror stories about badly injured or ill people waiting hours for an ambulance. Being a member of a medical scheme usually entitles you to use a private ambulance.
Maternity costs. Having a baby is expensive - even if there are no complications. Medical schemes will not cover you for your pregnancy if you only join once you are pregnant, so if you are planning to have a family, and you’re not a member yet, make a plan as soon as possible.
Check-ups. You know you should go to the dentist, the oral hygienist, the GP or the homeopath for regular check-ups. But you don’t, because it is expensive. You wait until something goes wrong, and then you go. And it ends up costing you three times as much. Prevention is indeed better than cure. And within specific limits, your medical scheme will pay for these check-ups.
Hospital plan vs medical scheme
Medical scheme centre
(Susan Erasmus, Health24, updated January 2013)