What to consider when downgrading or upgrading your medical aid

What to consider when downgrading or upgrading your medical aid

– Tanya Motlafe (Head of  Cornerstone Healthcare Consulting Services)

Medical aid option change season is in full swing and every member who belong to a medical scheme is busy re-evaluating their current medical aid and wondering whether it’s time to make a change. If you are in the same boat, wondering whether you should be making changes to your medical aid, this article is for you.

Cornerstone Healthcare Consulting Services believes in empowering our clients so that they can make the right medical aid choices – not only for themselves, but for their families as well. That’s why we have put together some important elements you should consider when upgrading or downgrading your medical aid option. Remember, no article can ever replace the advice given by a qualified medical aid broker, click here to get in touch with Cornerstone Healthcare Consulting Services for expert knowledge and advice.

Relook at your current health condition

First thing’s first – has your health requirements changed in the past year? If yes, how? A lot can happen in 12 months and you need to make sure that your medical aid keeps up with any changes. Some key areas to look for changes include:

  • Chronic conditions

Have you been diagnosed with any new chronic conditions such as high blood pressure and diabetes etc? If so, you need to make sure that your medical aid will cover your specific chronic condition including medication, treatments, procedures etc.

  • Day-to-day medical expenses

Perhaps you have started wearing glasses, or you might be visiting the dentist more often in the new year – whatever the case may be, make sure you assess any changes to your out-of-hospital and day-today medical expenses. If they have changed, make sure you choose a medical aid option that caters for these changes.

  • Planned procedures

If you are planning to undergo any planned procedures in the new year, double check if you ae covered for that specific procedure. If not, consider upgrading to a different benefit option. Even if your current plan covers the procedure you are undergoing, the doctor performing your procedure may charge more than the medical aid rate, meaning you will have to cover the shortfall from your pocket.

Luckily gap cover can help cover these shortfalls – click here to read more about the extreme benefits that gap cover can offer you and your family.

Changes in dependants

If any of your dependants have turned 21 in the past year, it might be better and cheaper to put them on their own medical aid instead of listing them as adult dependants. If your children are studying, some medical aids offer great and affordable student options as well.

Planning a family? Make sure you understand your maternity benefits

If you are planning a family or expecting, your maternity benefits on your medical aid will be a vital part of you and your baby’s health. Maternity benefits tend to differ widely between medical aid as well as benefit options so make sure that you choose wisely. The best way to ensure that you are properly informed is to appoint a qualified and experienced healthcare broker, click here to get in touch with Cornerstone Healthcare Consulting Services.

Check for any exclusions, especially when downgrading

You might be very tempted to downgrade your medical aid option in order to save on your monthly premiums, however, be careful of any exclusions. Exclusions are certain medical conditions that a medical aid plan doesn’t cover, or only partially covers. These exclusions usually apply to hospital plans and cheaper medical aid option, so make sure you know what procedures and conditions are excluded before downgrading.

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