By Albert Musakwa
Health is a gift that we tend to take for granted. We do not value it until sickness strikes or an unfortunate accident happens.
Many people hide behind the famous phrase “I never get sick”. Guilty as charged? The reality is, it may not always be you who needs medical attention. It can be your parents, your significant other or a child who lands in hospital due to unforeseen road accidents, sports injuries or stress related illnesses.
When most Zimbabweans are faced with an unexpected illness, condition or accident they depend solely on cash to fund treatment. According to the last statistics released, a small fraction of the population- 10%, can turn to their medical aid to cover treatment. This is despite the majority of the population having funeral insurance.
Uptake of medical aid has further been affected by the Covid 19 pandemic. The pandemic has impacted businesses and individuals in terms of revenues and disposable incomes. This has led to a continued decline in people subscribing to or taking up medical aid.
While most still see medical aid as an unnecessary expense, it remains a necessity. With the escalation in both cost of medical care and complexity of diseases, medical aid is a must for that unfortunate event.
What is medical aid, and why does it matter?
Medical Aid is a type of insurance that protects you financially should you require medical or health care. It covers medical expenses incurred while in hospital, receiving treatment from a specialist, GP or when seeking medication from a pharmacy.
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Picking a good, reputable medical aid is an essential part of alleviating the stress of worrying, providing you with the necessary financial cover when you need it. Accidents can happen, and your health, as well as that of your family, is unpredictable.
How do I choose the best Medical Aid?
When choosing an ideal plan, it is best to assess your life and understand the implications if you needed medical treatment. The best medical aid interacts and engages with bonafide medical practitioners who believe in improved health outcomes for their clients.
First, ask these questions:
- How long has the Medical Aid been in business?
It is imperative to ensure that the scheme is well established and financially stable. The market and medical practitioners prefer established brands with a sound track record.
- What do other people say about the Medical Aid?
Word-of mouth is vital as it helps you get a better idea about the product and is key in decision making. For example, some Medical Aid schemes are notorious for delaying payments, and most practitioners avoid them – leaving you as a member in the lurch.
- What is the level of shortfalls/out of pocket expenses?
It is not standard that schemes cover all expenses. Some medical aids only cover a percentage of their tariffs for the hospital. In that case, members would have to cover the shortfall if doctors or specialists charge more than the schemes rates.
- What is medical aid card acceptability by many provider networks?
Members should look at the acceptability of cards by service networks. These service networks include pharmacies, GPs, specialists or hospitals. Medical schemes are also increasingly introducing service provider networks to contain costs. A member should decide with the listed service providers in mind.
- How flexible are the products?
For example, medical aid schemes may exclude you from claiming for conditions for a limited time. Be aware of these possible exclusions before signing on the dotted line.
- What are the benefits?
Most medical aid schemes pay claims depending on the benefit option. The benefits can be in hospital and out of hospital benefits. These will financially protect you and have flexible day to day benefits, among others.
- What are the rules of joining and the applicability of waiting periods?
Medical aids are entitled to 3 months general waiting period at the medical aid’s discretion. The waiting periods are not always automatically applied. This depends on the health risk profile presented to the medical scheme.
What do I need to join/register for medical aid?
When you come in, remember to bring these:
- ID, birth certificate for children
- Membership certificate if leaving another Fund
- Medical Report on request from Funder
Albert Musakwa is the managing director of Generation Health
