Medical aid: it could be your life, death scheme!

MBABANE- Your life span as an individual depends fully on how healthy you are and there is no better way to live a healthy life than to have a medical aid cover.

Nowadays, most employers include medical aid cover as one of many benefits they provide. They offer to meet you halfway on your monthly subscriptions.

At my place of employment, the company pays for its staff in full.

Medical aid cover could sometimes prove to bring more unhealthy situations in one’s life, especially at a time of need. Before joining a medical scheme, make sure you understand fully what your medical benefits are. Sometimes you may assume that you are covered for any medical conditions should you fall sick. Most often than not, you are not.

Before you sign with any medical aid scheme, make sure you clearly understand what you are covered for in terms of your benefit options. Should you fail to do so, you could find yourself faced with additional financial difficulties when you have to pay for your medical bills. Even worse, medical schemes have a maximum amount that they will pay on benefits.

* A South African man is currently faced with a medical bill of E36 000 after his medical aid scheme refused to foot the bill following his child operation. The scheme’s argument is that they were not informed about the child’s operation and wonder who gave authorisation for the emergency operation. The client explained that it was an emergency operation and the doctors also wrote a letter to the medical scheme explaining the situation. The medical aid scheme still stands its ground and now the hospital wants its money from the man. He is appealing for funds to the public, although he had a medical aid scheme that he has been paying for several years.

* A patient who had undergone an intensive operation learnt with shock that he had to pay an extra E5 000 for his medical bills.

* A patient on a medical aid scheme, who had diabetics had to have one of her legs amputated. She was told she had to pay for the artificial leg separately as her medical aid did not cover the cost of purchasing the artificial leg.

* A patient who had to be transferred by a private helicopter ambulance to a South African hospital for medical attention received a private medical bill for the ambulance. He had to foot a huge bill.

* A patient suffering from eye vision could not replace his glasses for the second time in a year as he had exhausted his current year benefit.

* A patient who had to seek medical attention in South Africa was informed by the hospital that his medical aid scheme provider was in arrears with the hospital and they were not willing to treat her. She returned untreated.

* A patient was told by his medical aid scheme provider which hospitals to use as not all of them were credited by the provider.

To enjoy a peace of mind knowing that you are well-covered for any mishap, ask your healthcare provider for brochures or leaflets on all medical cover options. Compare the benefits with other medical aid providers and do that every year. Always remember that as a consumer you have the right to choose your own medical aid provider. Some workplaces enter into agreements with medical aid scheme providers for better deals. It is good to know how really good a deal is. Joining a medical aid scheme is now compulsory with a number of employers.

It is vital that you do not cancel your medical scheme membership just because you want to cut back on expenses. This act has become a norm to many a people because they feel healthy and last visited a hospital in a while. Remember that you could find yourself in deeper financial difficulties having cancelled your membership and now having to pay for yourself for expensive medical treat-ments. Such action could be an added burden and can lead to developing stress-related ailments, which are also very costly to treat. Some medical scheme providers are open to cash refunds at the end of the year. It is wise not to ask for such but rather question how best could your credit work for you in the following year, especially if you are to maintain the same healthcare provider in the following year.

You have the right to ask the hospital or clinic treating you whether they charge private or scheme rates. Try to avoid signing blank forms when asked by your healthcare provider. If you run your own business, you can also negotiate for a better rate if your healthcare provider intends charging you more.

The advantages of joining a medical aid scheme are;

* You can cover your entire family

* Your children will be covered until they are 21 years old

* You will receive special treatment and attention from most medical institutions when you are covered by a medical scheme

* You may not have money to treat yourself at the time when you are ill, but with medical aid cover you are sure to receive treatment. A number of patients have been denied treatment and subsequently died because they did not have medical aid.

* Your subscriptions are always calculated on reasonable rates and normally affordable depending on the benefit option you take

* Medical schemes are always ready to listen to your health concerns and to provide the services you will need.

South African state freight logistics group Transnet recently injected E500-million into one of its key pensioner medical-aid schemes in a bid to shore up the benefits for 26 000 of its former employees and their dependants.

Scheme members would be given the choice to either stay with the ring-fenced Transmed Guardian plan, to retain the cash (an option which Transnet was not recommending), or to join a new ‘open scheme’.

Under the new arrangement, Transnet would pay each principal member E730 a month; with spouses receiving E590 a month; children under 21 E250 a month; and disabled children over 21 also receiving E250 a month.

International medical-fund consultant AON had been contracted for two years at a cost of E6, 5 million, to provide advice and support to the pensioners having to make the adjustment.

Medical schemes common in the country include SwaziMed, SwaziCare and Mphilonhle.

Other countries have introduced schemes that only cater for patients’ hospital expenses. Neighbours South Africa is one of many countries that have Hospital Cash Back schemes.

These schemes are not medical aid but they cover for hospital bills that can be accumulated by a patient while at a hospital or clinic. A good example is that of a woman’s miscarriage. Your medical aid normally covers for the processes of giving birth and not hospital or clinic expenses that may occur due to a miscarriage.

It is worth noting that your hospital telephone bill will not be paid by your medical aid scheme but a hospital cash back scheme does pay for such expenses and also provides cash refunds once discharged.

Before signing for any medical scheme, it is vital that you test for any other illnesses as some schemes do not cover individuals with certain illnesses.

The plight of tuberculosis and its treatment in the Shiselweni region will be on display at the Mbabane Theatre club on Tuesday at 5pm.

The 10-day event, which has been organised by Medecins Sans Frontieres, otherwise known as Doctors Without Borders’ head of mission Aymeric Peguillan, will end on April 9.

"Tuberculosis is a big challenge, it is important that we inform the nation on the effects of the disease and how best they can treat themselves. We have decided to set-up camps that are closer to the people as most communities have to travel long distances to health centres. All the photos that will be on display have been captured in the Shiselweni region", said Peguillan.

The ‘Beyond the road’ TB campaign will also be launched during the exhibition. The next exhibition is expected to take place in Nhlangano soon.

Remember that the month of March is consumer month. World Consumer Rights Day was commemorated on March 15.

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