07 January 2016

SASA urges consumers to be careful about decreasing medical cover

The South African Society of Anaesthesiologists (SASA) is warning people not to compromise their medical cover because of a tight financial position at the beginning of the year.


The year-end sees many people being paid much earlier in the month cycle, to accommodate the festive-season retail period, and often there are more expenses in this period and considerable difficulty in covering expenses for the six to seven weeks that a normal month’s salary needs to cover.

Potential short-term gains

“People’s pockets often bleed money during the festive season, with children home for an extended period of time, as well as travel and other holiday financial pressures,” says SASA CEO Natalie Zimmelman.

Read: What you need to know about PMBs in 2016 

People are warned against making decisions based on potential short-term gains, as this might very well cost them in the long run – by lowering monthly costs for medical cover, they can potentially increase their exposure and risk, leading to a high bill not being covered. While a decision to downgrade medical cover might be a valid choice, one needs to consider very carefully whether there will be money to cover the potential medical bill that may arise.

“Caring for patients involves a holistic approach for us, including caring about their financial well-being. Our members are trained to the highest standards and ensure that patients are cared for before, during and after surgery,” says Zimmelman.

Understanding what is covered and excluded in various medical cover options is important to ensure that any decision to downgrade suits the lifestyle and not just the pocket. It does not help to know that your medical aid will pay a set amount for treatment, without understanding the full cost of such treatment.

Read: Consider this when choosing a medical scheme

Medical scheme rates, especially on lower cover options, may not reflect what it actually costs for you to receive the treatment, particularly for scarce and skilled specialists such as anaesthesiologists. Their skills, training and occupational risk are considered in their rates, and this may not correlate with medical scheme benefit complexities.

Financial peril

Patients need to make sure they know what they are losing at a lower monthly rate or gaining at a higher rate in rand terms. They also need to check the long-term affordability of taking the higher risk, and know what is covered relative to the medical costs, as well as what co-payments they will likely have to bear.

Though it can be difficult to understand the benefits being offered and difficult to compare with other medical schemes, get in touch with your medical scheme or medical cover provider to ensure you understand. If that process is not satisfactory, get in touch with the Council for Medical Schemes for assistance.

“Speak to your medical scheme to ensure you don’t compromise on benefits for your health, putting yourself in financial peril for treatment,” advises Zimmelman.

Read more:

Medical Schemes Act: proposed amendments to PMBs

New amendments to medical scheme act should keep medical inflation in check

SA medical schemes in favour of improving clinical quality healthcare

Image: Jar with medical savings from iStock