What is Insured by Your Medical Scheme
The majority of people covered by medical schemes are covered through their employers and therefor they are sometimes uninformed about their policy and unsure about what is insured by their medical scheme. Medical schemes can not pay all your health costs completely.
You must be informed about what exactly will be covered by your specific medical policy as terms and conditions do vary by insurers. The most medical policies cover health problems that are curable or short-term and allows you to be diagnosed, receive surgery or be treated in certain situations, although some treatments fall outside the range of cover
Check the documents of your medical policy for:
Chronic diseases
Some medical schemes will easily cover any acute conditions that is short-termed and curable but they do not cover long-term diseases that are incurable and therefor classified as chronic. Examples of chronic diseases that are not covered include Diabetes, HIV/Aids, Asthma and TB (Tuberculosis).
A patient suffering from certain types of ill health, for example leukaemia or other kinds of cancer, can at first be classified as curable, but as the cancer deteriorates it can become incurable and changed from acute to chronic. This reclassification during treatment by the medical insurers can lead to immense financial problems.
The term of treatment
Medical aids may vary on their decision of payments on treatments, some may pay for only a certain amount of doctors' visits or only short-term treatments. This must be taken in consideration when an extended medicine prescription is given and the medical aid only pays for the first few prescriptions. Insurance companies pay for curing and treatment of conditions but not for preventative treatment.
Paying only for approved medicine
A list of approved medicine should be available to insurers on request as some medicine is not approved and the medical aid would only pay for a similar medicine or a generic medicine. The policyholder may choose to use the prescribed medicine but then be held responsible for the difference in cost of the approved medicine.
Conditions that pre-existed
Claims for treatment of conditions that existed before the policy, may be seen as invalid and therefor the medial aid companies insist you complete an clear-cut questionnaire or a letter from your doctor on your medical conditions before they agree to insure you. Some medical schemes would only pay for childbirth after a certain amount of monthly instalments and compel you to wait for anything between 3 and 12 months before conceiving. Your policy should be studied carefully for all these finer details that could prevent huge disappointment and financial burdens.
Annual renewal of your contract
Each year a reviewed premium could be expected as well as a change in provided coverage of conditions. Your policy changes and could decide to no longer cover particular treatment or because of medical research, could decide that a specific treatment will now also be covered.
This reclassification and more costly new treatments can lead to medical aids paying out increasing claims and this indirectly affects you by with increased monthly premiums.
It is very important for you to contact your medical insurer to confirm coverage of certain medicine and treatment when you are uncertain because a medical policy tend to have a lot of grey areas.
For a free consultation about your medical insurance requirements, let a Liberty Life consultant contact you (free of charge) - www.liberty-life.co.za