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Make your benefits last longer this year

  •   by Medihelp
  •   28 January 2016
  •   760 view(s)
It is a new year, which means your medical aid has new benefits available or there are again plenty of funds in your savings account, but this does not mean you should use these benefits irresponsibly at the beginning of the year, leaving you with little or nothing later on.

The Council for Medical Schemes (CMS), which regulates the medical schemes industry, warns members to use their benefits wisely in a recent press release.

Daniel Lehutjo, acting Chief Executive and Registrar of the CMS, says now that members have chosen to either stay on the same benefit option or move to another one, they should resist the urge to spend all their benefits in the first few months to avoid running out of cover when it may be needed the most later in the year.

“We appeal to members to also use their medical scheme benefits wisely and spread the use of it evenly during the year. Make use of your general practitioner (GP) to coordinate your care and discuss any healthcare needs and concerns for the year.”

Lehutjo further says that members should not use their benefits to buy sunglasses, multivitamins or other lifestyle items over the counter. He also says members are advised to ask their doctors to prescribe formulary drugs (drugs that will be funded by medical schemes for specific conditions). A formulary regularly consist of generic medication which is much cheaper but equally as effective as the more expensive alternatives.

He adds that members are encouraged to make use of the preventative screenings and tests offered by their schemes. “Members should also seek to register on the relevant chronic management programmes if they have certain illnesses, thereby ensuring their condition is monitored and that they receive all the necessary care,” explained Lehutjo.

Tips by the CMS to reduce out-of-pocket expenses:
• Ask your medical scheme who the DSP is for the service or product that you need.
• If you need to undergo an operation, ask your surgeon for the codes that will be charged. This will include the procedure codes and those for any other products you may need, such as an internal prosthesis that will be used.
• Discuss the medical scheme tariff with your surgeon and negotiate the fee that he will charge.
• Contact your medical scheme and ask whether the specific type of product will be funded in full. If not, make sure you know how much will be for your own pocket.
• Where possible, shop around for providers of medical services that will give you the best deal, e.g. pharmacies or optometrists who run special promotions.
• Determine if there is a shortfall and make plans to fund this.
• Obtain pre-authorisation for procedures as provided for in the rules of your medical scheme.

Join Medihelp Medical Scheme today

Joining Medihelp is easy – simply speak to a Medihelp adviser who will explain all our benefit options to you, help you select the right option and facilitate your application. Click here and a Medihelp adviser to contact you.

Related articles:
The difference between network and non-network options

Generic vs brand-name medicine

Quality healthcare at an affordable rate

Source: The Council for Medical Schemes (CMS)
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