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Manage your cover responsibly
It is important to both manage your healthcare cover and understand some of the procedural requirements on your part. If you don't, you could be considerably out of pocket further down the line. To experience the true value of a medical scheme requires some forward planning.

Herein lies the problem. We live in an age where much emphasis is placed on the here and now. Looking to the future is not always an appealing option when demands on our time and finances mean that we are preoccupied with day-to-day considerations.

Peter Moyanga, Medshield Chairman, urges South Africans to think of their medical scheme as a lifelong healthcare partner, "Keep your medical scheme in mind when planning for the future and remember that it’s a two-way relationship. Doing your homework on the scheme’s policy on payment of claims and general cover can save you time and money."

Overlooked issues: easily avoided
Assuming you’ve realised the benefit of medical cover and have found an option that works for you, don’t make the mistake of forgetting all about your healthcare partner until you need a claim paid. Moyanga advises that there are some common problem areas which members frequently experience, all of which can be attributed to lack of knowledge on the part of the member. These issues can be easily avoided and include the following:

• The three month rule: Most schemes require the member to submit any claims for payment within three months. It is the member’s responsibility to ensure this deadline is met. Failure to do so will result in the claim becoming stale and the scheme will not cover the costs. A simple rule to remember, but one which unfortunately catches many people.


• The rate debate: A medical scheme pays claims at the rate stipulated by that scheme. The scheme member is liable for the shortfall resulting from medical practices charging rates higher than the scheme covers. Some medical schemes will pay for costs originating from above scheme rates, however this is at an additional cost to the member. Ask your broker about options that bridge this gap – you may pay marginally more in your premium each month, but you’ll be covered for considerably more.


• Pharmacy fees: Most pharmacies charge an admin fee when submitting a medication invoice to your medical scheme for payment. Most schemes do not cover this fee. You can avoid this fee if you instead pay cash for your prescription and submit the invoice to your scheme yourself.

Knowing about issues such as these will enable you to make full use of your medical scheme cover. But the first step is to realise the importance of partnering with the right scheme to begin with.

Moyanga encourages South Africans simply to think about some of the healthcare milestones and resulting financial implications they are likely to experience in the next few years. He comments, "Planning for a child or considering the possibility of you or a family member developing a condition to which you may be pre-disposed are all potentially expensive occurrences. Don't wait until they happen before you seek the cover that will save you from financial strain. And once you are covered by a medical scheme, ensure you are getting the most out of your cover. It's what you’re paying for."

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