06 July 2011

HIV, cancer and medical schemes

Being a member of a medical scheme is a necessity. Having medical cover provides security in the event of a medical emergency and will cover your day-to-day medical expenses.

Being a member of a medical scheme is a necessity in today's world. Medical expenses today are higher than ever. If a member of the family has to see a doctor or be hospitalised, and you are not adequately covered, your out-of-pocket costs are likely to be a lot higher than you might ever have planned for.

Broadly speaking, most schemes offer various choices between comprehensive medical scheme cover on the one end of the spectrum – which will pay for a wide range of services such as doctors' consultations, tests and medical treatment – and hospital plan cover on the other end, which is a lower-cost medical aid option that only covers hospital expenses.

  • How often do members of the family visit the doctor, dentist and other healthcare practitioners?
  • What annual check-ups and tests will members of the family require in the coming year (such as mammograms, cholesterol tests, cancer screening, bone density tests, etc)?
  • Are you planning any major medical procedures, such as pregnancy and operations?

  1. What are my benefits for chronic and serious diseases (such as HIV and cancer)? For example, will my scheme pay for antiretroviral treatment, chemotherapy or radiation, and under what conditions?
  2. Do co-payments apply? (A co-payment is when the medical scheme pays only a portion of the medical bill and the member is liable for the balance.)
  3. Are the benefits relating to specific conditions limited?
  4. Is all additional medicine covered?
  5. Are there limitations relating to which healthcare providers will be paid for?


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