Medical Aid Advice

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remybfg10k

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Mostly aimed at Lancelot as he seems to be quite knowledgeable :)

I have till tomorrow to change or stay on my Medical Aid:

SARS offers the following:

Discovery Health | Bonitas | MediHelp

I have one adult dependant (partner) and one child dependant (18 months)

I earn double what my partner earns, they have also now offered her the change to be on Discovery.

First question:

Would it be wiser for me to stay on as the main member and her as the dependant, or would it be cheaper for her to be the main member and me as the dependant (seeing as the medical aid rate is linked to your annual/monthly salary)

Second question:

We are currently on Classic Priority (started here on 1 may) and our MSA ran out in September already.

Would it be wise to stay on this or rather move down to a lower choice, seeing as we have paid alot out of our pockets (one was a co-payment for grommets)

Now in the new year, i'm thinking of having my tonsels taken out, also my daughter has bandy legs, so we will need to take her to a childrens orthopaedic surgeon for a full consultation (she's been looked at by a couple of people, a doctor, chiropracter etc and they were not worried at all, also doing some research on the net it does seem that it will come right naturally, but rather safe than sorry)

Any thoughts/suggestions as two things i cant comprehend:

Tax returns & Medical aid schemes :p
 
My thoughts are always (with 1½ children of my own) go Hospital Plan. Full medical aids are for the elderly. Why subsidise the system even further during your younger years.
 
carudden, just a thought to be added, choosing a hospital plan also can affect my net income a month, i.e. less money is non taxable?
 
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That all sounds to technical to me now :p
My wife and I are currently both on seperate Hospital plans through Discovery.
 
I know many people dislike discovery but I have to say that I quite like them. I'm on classic comprehensive and while it costs a pretty penny every month it's a damn sight cheaper than paying all my medical bills personaly. Once my MSA is depleted I have a R1500 self payment gap and then move over into above threshold benefits which covers pretty much everything again. My chronic meds that I would have to pay in the region of R1000 - R2000per month (depending on the medical aid) - the total monthly costs being R3500 - with other medical aids only costs me R188 per month on Discovery.

Having said all that, it is very important to investigate each medical aid thoroughly as different plans / schemes suit different people for different reasons. I for example could not be on a hospital plan because I have high out of hospital expenses (specialist visits, medicine side effects that have landed me in emergency rooms twice this year, non medical but health related treatments that would otherwise have cost me R15000 through other medical aids etc etc). In light of that it works out cheaper for me to be on a higher plan.

Does your HR department not have a broker that can help you choose the right medical aid?
 
It's quite annoying that brokers usually sell only one company's product. Usually the broker would be the best person to advise you but in our case, the broker will just tell you to go with what he's selling.

a crying shame.
 
I would choose Bonitas ...... best out of the 3 but that's just my 2c.
 
They just seem to have better priced and laid out 'plans' and benefits IMO. Never had any runaround with them either (no specific doctors, dentists, etc).
 
I don't think it works out cheaper to be on a higher plan, i am with spectramed hospital plan and i have never found the need for full medical aid. I have saved like 10-15k a year on a hospital plan.
 
killa, but you understand the tax implications though? Just because i wont pay R2,000 extra to medical aid won't mean i come out with R2,000 extra in my pocket...
 
Well the thing is if it saves you money go cheap, if it does not go for full cover.

If you not going to come out witht he extra money than just go with a full medical aid :)
 
Sorry Remy, I was at work today which means I did not get to see this until now as I usually do not come on here while at the office :)

I am not sure whether your questions have been answered as I have not read through this thread yet but saw your PM linking to here.

As matter of interest I posted a link before which allows you to compare a number of medical schemes. It is :

http://www.msit.org.za/

Perhaps compare the ones you can choose from and then ask any questions which arise.

Something I did spot you asking was about medical savings. These are pro rated for the year so if you only joined a fund in May you would only have received upfront savings for 8 months.

For any specific procedures it is always better to check up front whether it is covered as each medical aid will differ. There may also be co-payments if the procedure is covered. Remember on most medical aids most procedures for which you are admitted are covered, but not sure if they admit you for tonsils.... I don't think so any more(?).

You say SARS is offering it. Are you and your partner employed by them? Usually the salary bands would be worked out on the employees income and not the spouse.
 
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Hi Lancelot,

Thanks for the help, really appreciated!

I am employed by SARS, my partner works for Gautrain, so i had her and my baby added as dependants
 
So i did a compare between Classic Priority and this new Essential Delta Saver

There is a pre-tax difference of : 1389

Essential Delta Saver : 1745
Classis Priority : 3134
Vitality = 128
 
Lancelot, any idea what this Reimbursment rate for Generic Medicines part is? Its says 100% for Classic Priority, but 0% for Essential Delta Saver
 
remybfg10k said:
Lancelot, any idea what this Reimbursment rate for Generic Medicines part is? Its says 100% for Classic Priority, but 0% for Essential Delta Saver
Click to expand...

I'm assuming this :


Day-to-day benefits

All day-to day benefits will be paid up to the limited Above Threshold Benefit or up to the limit that applies below, whichever you reach first.

Classic Priority
Medicine
Prescribed medicine (schedule 3 and above)
Single member: R9 250**
Member with one dependant: R11 200**
Member with two dependants: R13 500**
Member with three or more dependants: R14 750**

Over-the-counter medicine, including prescribed schedule 0, 1 and 2 medicine and lifestyle-enhancing products
We pay these claims from available funds in your Medical Savings Account.



Essential Delta Saver
Medicine
Prescribed medicine (schedule 3 and above)
The claims for these expenses are limited to available funds in your Medical Savings Account.

Over-the-counter medicine, including prescribed schedule 0, 1 and 2 medicine and lifestyle enhancing products
The claims for these expenses are limited to available funds in your Medical Savings Account.




So in other words with the delta series day to day medicines come out of your savings. Priority, schedule 3 and above you have a limit for.
 
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superB said:
I know many people dislike discovery but I have to say that I quite like them. I'm on classic comprehensive and while it costs a pretty penny every month it's a damn sight cheaper than paying all my medical bills personaly. Once my MSA is depleted I have a R1500 self payment gap and then move over into above threshold benefits which covers pretty much everything again. My chronic meds that I would have to pay in the region of R1000 - R2000per month (depending on the medical aid) - the total monthly costs being R3500 - with other medical aids only costs me R188 per month on Discovery.
Click to expand...

Similar options are available on a lot of medical aid schemes... you need to ensure you are comparing apples with apples and not a comprehensive plan with a hospital plan.

Most plans cover chronic medication under "prescribed minimum benefits" too. So as stated by you a person needs to decide what they need from their medical aid and then do some research from there. Chronic medication will not be of importance to a lot of people but comprehensive hospital cover may be.
 
Lancelot, i am going to ask you some hopefully not too dumb questions if you don't mind?

Say i was a twin, and my twin was on classic priority for 2009 and i was on essential delta saver.

On the 2nd jan we get a cold, we both go to our discovery gp network doctor, we both pay R120 out of our savings.

We then go to dischem with our prescription of cough syrup (it costs R100 retail at Dischem)

Do we then both pay our of our Medical Savings for the syrup or will i need to pay cash out of my pocket for it?
 
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