14 May 2021
South Africa has 21 open medical schemes which together provide the public with 261 different scheme options to choose from.
Cover for these scheme options differ in respect to the type of treatment and medicines. Cover can be provided for the amount needed for each treatment. Accordingly each scheme option charges a different monthly premium to access their benefits. This wide variety allows individuals and families to select a scheme option that meets their unique healthcare requirements and affordability.
Comparing different options and assessing the suitability of each option against your specific needs and financial circumstances can make this process difficult. Using a qualified and experienced medical aid broker will enable you to make an informed choice and ensure you are receiving the optimum cover at the most affordable premium.
Medical aid brokers come at no extra cost to you as they earn a commission directly from the medical schemes. This commission is already priced into your monthly premium which won’t decrease in the absence of an appointed broker.
Your medical aid broker should be servicing you in the following ways:
Advice and Support
- Your broker should conduct ongoing needs analysis for your cover to ensure the medical aid option is the most cost effective and matches your unique healthcare funding needs.
- Advice on ways to maximise the healthcare funding and benefits you receive from your medical aid.
- Support and assistance in maintaining your medical aid membership e.g. dependent registrations / de-registrations.
- Assistance with understanding your annual option changes and any industry changes that occur.
Claim Management and Dispute Resolution
- Claims support and intervention with the scheme on your behalf on submitted claims.
- Guidance on utilisation of Prescribed Minimum Benefits (PMB) entitled claims.
- Disputed claims management.
Chronic Medication Benefit Utilisation
- Guidance and assistance on chronic registration processes.
- Communicate rules and guidelines related to obtaining your medication and ongoing treatment of your condition.
The information contained in this communication, including attachments, is not to be construed as advice in terms of the Financial Advisory and Intermediary Services Act of 2002 (“FAIS”) as the writer is neither an appointed representative of Zestlife, nor a licensed financial services provider as contemplated in FAIS. Please consult your Financial Adviser or Zestlife should you require advice of a financial nature and/or intermediary services.