South Africa: Stretch your medical savings funds and keep cash in your pocket
Every year a significant number of South Africa’s eight million medical scheme members find themselves in the unenviable position that their medical savings funds (MSF) have run out long before the end of the year.
“Often medical scheme members who run out of savings funds, have not made sufficient provision for out-of-pocket expenses and do not have the extra cash readily available to pay for their day-to-day expenses, invariably prompting them to cut back in terms of medicine and treatment. This may well impact negatively on their health, which, in the long run, could lead to further costly health complications that may even be impossible to treat effectively,” says Andrew Edwards, Executive Principal Officer for Liberty Medical Scheme (LMS).
“It’s therefore vitally important that medical scheme members treat their MSF with the same circumspection and prudence that they apply to financial planning so that they can stretch their rand as far as possible to ensure that they don’t end up having to pay for medical bills out of their own pocket before reaching the end of the year,” says Edwards.
Edwards offers the following advice to help members make the most of their MSF this year:
- Familiarise yourself with the scheme rules to ensure that you know what is paid from your benefits and what is paid from the MSF. Members should also determine how much money they can spend on the different health services such as optometry, dentistry, physiotherapy, etc and try not to exceed the amount. This information is included in the option details, of which members receive a copy, or it can be obtained from your scheme’s contact center or your financial adviser.
- Medical scheme members should also ensure that they are aware of exactly what their plan covers as well as its limitations, in order to avoid unnecessary costs that will be funded through their MSF.
- Instead of visiting a doctor for minor illnesses at the first signs of flu or a head-cold and paying consultation fees, it’s advisable to revert to your pharmacist to advise you on medication that is available over the counter without a prescription and which is often most affordable.
- Before you consult a medical professional, make sure you are aware of the rate the doctor charges compared with the rate at which your scheme pays out also known as the scheme rate. Many service providers often charge higher than the scheme rate, leaving the member to pay the difference out of their own pocket.
- If may be worth your while to check with your doctor if a discounted rate is available for an upfront cash payment. The member can then claim the discounted fee from the medical scheme.
- Many medical schemes have agreed contracts with certain service providers, and this means that members who use the services of these practitioners pay the pre-agreed rate. Make sure that you are familiar with any service provider plans as they may save you money.
- In terms of medication, check with your pharmacist or doctor if a generic option is available. While generic medication is based on the same formula as that of the original ethical/patented medication, it is more affordable as it is either non-branded or has come off its patent, meaning the licence to produce the medication is open to more than one drug company.
- Most medical schemes require members to register for a chronic condition before payment is made from their benefits. If you are not registered, you will continue to pay from your MSA, therefore you should determine whether your chronic illness is a Prescribed Minimum Benefit (PMB) condition. Registering your condition with your medical aid will save you substantial sums of money as medical schemes are legally required to cover PMB conditions.
- Ensure you keep scheduled doctors’ appointments, as doctors could even charge the full consultation rate for a ‘no show’.
- Keep a record of all doctors’ bills that you have paid for out-of-pocket so that you can submit a medical tax certificate (out-of-pocket expenses) to the South African Revenue Service (SARS) as well as for certain extra medical expenses incurred over the tax year, which are tax- deductible.
- Check your member statement on a monthly basis to ensure that you are not charged for any services that was not rendered to you.
“By working closely with our members every step of the way and informing them on how they can make the most of their medical scheme and savings funds, we not only demonstrate that LMS deeply cares, but we also empower them to do the necessary planning to optimise their savings funds, ensuring peace of mind,” says Edwards.
“In addition, our registered and accredited financial advisers ably assist members in selecting the option best tailored and suited to their unique needs and those of their dependants and equip them with the knowledge in order to understand how their medical option works, what it covers and what it doesn’t.
“Should members be uncertain of any aspect of their plan, it is vital that they either consult their financial adviser or a call centre consultant to ensure that they have access to healthcare when they need it most,” Edwards concludes.
