Medical Aid help!

[CrazyMadMan]

Hey guys my family an I need some advice. My wife is a teacher for the government and as such we have been on GEMS, the government employee medical scheme. We have just had a baby and on top of that my wife is moving to a private school and therefore off GEMS.

Please share your thoughts on options for schemes. We want as comprehensive cover that will allow us peace of mind for our child as well as us. We both hold degrees I'd this counts in terms of schemes like Profmed etc.

Any advice will be appreciated.

 

[Jings]

Hey guys my family an I need some advice. My wife is a teacher for the government and as such we have been on GEMS, the government employee medical scheme. We have just had a baby and on top of that my wife is moving to a private school and therefore off GEMS.

Please share your thoughts on options for schemes. We want as comprehensive cover that will allow us peace of mind for our child as well as us. We both hold degrees I'd this counts in terms of schemes like Profmed etc.

Any advice will be appreciated.

If you're still interested in staying on GEMS they do accept individual members in terms of ex-employees of the state, provided there is no break in membership.

Profmed is a bit pricey, their membership base is too low to sustain more reasonable premiums. That said, their benefits are quite comprehensive on their top plans.

Are you looking at traditional or new generation (savings)?

 

[CrazyMadMan]

I am unsure, could you explain these?

 

[Jings]

I am unsure, could you explain these?

Traditional options give you set limits for your day to day, for example allowing 12 visits to a GP or R2000 for optometry.

Savings plans only restrict day to day usage in terms of the savings limit. Comprehensive savings plans have a built in threshold, allowing for claims to be paid from risk once the threshold is reached. Normally there a sub-limits on benefits such as medication and optometry which do not accumulate to threshold once the limit is reached.

 

[CrazyMadMan]

What do you advise?

 

[Jings]

What do you advise?

The best would be to speak to a broker and ask for a comparitive analysis (premiums and benefits) accross a few medical aids.

Questions to keep in mind:
What the medical aid does not cover?
Are procedures like MRI and CT scans paid from risk or savings?
Is the credit rating (claims paying ability) at least at an AA- level (lowest BBB-, to highest AA)?
What is their HelloPeter compliments and complaints ratio?
Is the administrator ISO compliant?