Make your medical scheme work for you

A medical scheme, like car insurance, is a grudge purchase. It feels like a huge amount of money I am paying out each month, and years could go by without me making any really large claims. But I know that when I really need it, I will be covered. Or so I hope.

Small print hides many things and the onus is on us as medical scheme members to know what lurks in the detail. Think about it:

• Do you know how much your scheme will let you spend on cancer treatment?
• How much will your scheme pay if you see a doctor at a private hospital not on their network?
• Do X-rays come out of your medical savings account?
• Do you have a facility for over-the-counter drugs?
• How much can you spend on chronic medication?

These are not things you want to be confronted with only when a crisis situation arises. In this case, knowledge really is power.

I often hear people saying with pride that they haven't claimed a thing from their medical scheme for years. That isn't really anything to be proud of: regular check-ups can prevent major health crises. Why wait until things fall apart before dipping into your medical savings account? It's your money. Spend it, but spend it wisely.

Here are some quick tips on making your medical scheme go as far as possible:

• Use generic medication where appropriate
• Switch to GPs and specialists on your scheme's network (if they have one)
• Register regular medication as chronic medication
• Remember that you can always try and negotiate tariffs with private doctors
• Many doctors give cash discounts – make use of these

And lastly, remember to check on an annual basis that your scheme option still is the right one for you. As you grow older, a hospital plan, although a lot better than nothing, might no longer be adequate. At the same time, there is also no point in choosing to stay on the most expensive option of your medical scheme if you can't pay your rent.

Be wise, be healthy, be informed, and read the small print.

Do you know if your medical scheme's cover is sufficient? Have you checked recently that it's still the right one for you? Share your thoughts with us.