5 questions to ask when deciding on a medical aid scheme
Boiling it down to the five questions that actually move the needle when picking a scheme.
If you’re shopping for a medical aid for the first time — or after a major life change — these five questions cut through the marketing noise.
1. Hospital network — is my preferred hospital in it?
Schemes lower premiums by limiting you to “network” hospitals. Cheaper, but only if your local hospital is on the list. Always check.
2. Chronic medication — is mine on the formulary?
Every scheme has a list of chronic medications it covers in full. If yours isn’t on it, you’ll pay co-payments forever.
3. Specialist co-payments — what triggers them?
Some plans pay specialists at scheme rate; others pay 200%, 300% or 400%. The lower number means you’ll owe the difference.
4. Day-to-day limits — what’s the family threshold?
Day-to-day benefits run out quickly. Find out what the cap is, when it resets, and whether unused limits roll over.
5. Waiting periods — am I switching mid-year?
If you’re moving from another scheme, you may waive condition-specific waiting periods if you’ve had continuous cover. Ask whether your move triggers any.
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