Medical Schemes and Gap Cover
- Do you belong to a medical scheme.
- Do you understand how your medical scheme works?
- Is your chronic medicine registered as such, do you make use of your
designated service providers to save on co-payments?
- Do you understand medical formularies on your medication?
- Are you on the correct option according to the current needs of your family
and are you aware that you can change options at the end of each year?
- Do you have gap cover to cater for hospital co-payments and specialists that charge more than medical scheme tariffs during approved procedures?
- Do you know which ambulance service to call in case of an emergency and is the necessary stickers on your vehicle to alert bystanders in case of an emergency on the road?
- Did a family member sign the necessary POPIA act authorization to receive your medical information when you cannot speak for yourself?
When it comes to medical scheme, it is not only important to choose the correct plan for your family’s needs, but also to make sure that you understand how it works. You can save a lot of money just by making use of the designated service providers, to use medicine within formulary and to manage your statements and check if your claims are processed correctly. There is a tendency for specialists to charge up to 300% of the medical scheme tariff when performing authorized procedures, thus causing major financial implications if you do not have gap cover. You can also change your option within your medical aid according to your family’s changing needs each year end, that decision is not to be taken lightly and is best to discuss with your financial advisor.