WITH most medical schemes launching their 2018 benefits and increases during September and October this year, medical scheme members have, to make important decisions about the selection of their benefit options, or even changing medical schemes in the new year.

Every month a big chunk of your income goes into your medical scheme contribution. For many people, it remains a grudge purchase – that is, until there is a medical crisis in your life and the scheme foots the bill.

The complexities of the medical scheme industry make it a veritable minefield which the average client (or member) finds extremely confusing.

Major issues for members

The major issues for most medical scheme members remain the following:

  1. Selecting a suitable benefit option offered by one of the 23 open medical schemes.
  2. The high annual contribution increases (higher than CPI inflation and salary increases).
  3. The reduction of benefits.
  4. Possible co-payments.
  5. Understanding the exact benefits, what you are paying for (including prescribed minimum benefits, chronic medication and the medicine formulary, dental benefits, hospitalisation, and day-to-day benefits).
  6. Understanding the structure of the benefits (medical savings account, self-payment gap, above threshold benefits).
  7. Understanding the structure of membership (is it a main member + 1 or 2 or 3, or is it a parent/adult/child structure?)
  8. The smooth running (hopefully) of the claims procedure.

While members have the option of joining any open medical scheme directly and without the assistance of a broker, a good medical aid broker can be instrumental in assisting you.