Medical Aid

[arendoog]

Must have a hospital cover .The rest you can pay yourself .i have used Medihelp dimension hosp cover for almost 20 years .They cover all the big hospital admitted things and also give some out of hospital cover like MRI,S and preventative examinations like mammograms ,cholesterol ext .I have compared to others and always end up with them again .Medical aid not Medical lifestyle plan like vitality 

[Captain Fastbastard Mayhem]

Myles Mayhew,

 

Is Zest gap cover any good?

Their basic gap cover ticks all the boxes. Pays for PMB's, 500% coverage, co-payment protection for MRI / CT scans and certain scopes etc, but their cancer "topup" is more expensive than a Severe Illness benefit would be with a normal life insurer (which consequently gets you far more benefit) and their exclusion on internal protheses and neck & back procedures is a bit harsh at 6 months 0% coverage and 6-12 months 50% coverage. 

 

Their maternity exclusion is better than the market at 10 months instead of 12, and their "no annual limits" is a bit of a misnomer given that the highest ever payout for gap cover is in the region of I think R 250k or so... 

 

Their additional dental benefit looks okayish, but there is another provider that offers better coverage (forget their name - it's not really something we sell)

 

The other point is that while Complimed cover the whole family no matter what med aid they're on (so families with Husband & wife on diff med aids have full coverage and don't need separate gap cover policies) Zest only cover the members listed on the member certificate - so if you're on 2 separate med aids, you need 2 separate gap policies.

 

Otherwise - it looks pretty good. I just don't know how they are from an administrative perspective... There, Complimed (well, Constantia Insurance, really) are very good... 

 

I certainly see no reason for someone to avoid them, like I would with Resolution... 

[Captain Fastbastard Mayhem]

Must have a hospital cover .The rest you can pay yourself .i have used Medihelp dimension hosp cover for almost 20 years .They cover all the big hospital admitted things and also give some out of hospital cover like MRI,S and preventative examinations like mammograms ,cholesterol ext .I have compared to others and always end up with them again .Medical aid not Medical lifestyle plan like vitality 

I must point out that Vitality is COMPLETELY separate to Disco Health. They have nothign to do with each other, despite what some med aids claim. No cross-subsidization, no nothing. 

 

Yes, the Vitality members do end up costing DH less, cos we essentially take "better care" of our health when compared to non-vitality clients (claims stats prove this over the last 20 years) but they are both separate entities entirely

 

And Medihelp. Eish... Come let us know when they strip your benefits entirely 'cos the majority of their members are old & sick. 

Edited November 9, 2015 by Myles Mayhew

[arabsandals]

hey bro... done the calcs on this before, and I can do them again if you want me to...

 

Essentially, it only makes sense to be on classic comp if you're going into the ATB every year, and using it extensively. Otherwise, the extra monthly savings from Coastal Saver (which you'd be fine on) would offset the effect of the lower MSA. 

 

Coastal Saver chronic coverage for those 27 PMB conditions is pretty much the same as the Classic Comp, except they have a marginally lower Chronic Medicine Coverage IF you don't use the approved medication for the condition. And by marginal, i mean marginal...

 

Yes, the extra MSA helps if you're not that good at putting money away, but the cost savings (if you don't need it one year) are worth it. 

What about the new smart plan? seems good to me. Almost like an MSA with the R50 GP copay but no 25% additional payment which invariably doesn't get used.

[Captain Fastbastard Mayhem]

What about the new smart plan? seems good to me. Almost like an MSA with the R50 GP copay but no 25% additional payment which invariably doesn't get used.

yeah, it's a good option for some people, who don't mind not having a dedicated GP and / or prefer one of the hospitals on the network. Also has cover for MRI & CT scans with the same copayments as Saver plans (except you pay out your own pocket / gap cover pays) 

 

Also very cost competitive with the Core plan... I'd like to try it out myself next year... We fit the profile, seeing as we don't go tot eh doc and our closest network hospital is our hospital of choice, so included with the ability to change back to your old plan if you're not happy with it (within 4 months) it's looking like a good option.

[Frosty]

I was on Classic Comprehensive at my previous employer, which was compulsory and I couldn't opt for a cheaper option (they were paying 50%). You can imagine 12 years of very few claims - I had a 6-digit worth of accumulated medical savings account.

 

Last year, I left the company and wanted to keep continuity with Discovery, so I have been funding my medical aid 100% since then. I felt almost R9K per month was a bit excessive so I downgraded for 2015 onto Classic Core which was a mistake in hindsight, but has worked out well so far - at least my MSA was paid back to me - which I have deposited into my home loan (and use it as a short-term MSA). I've had to fund a few visits out of my pocket, but that's where the access bond helps.

 

I saved about R4K, so decided to invest R3K of those savings (long-term) and keep the R1K in reserve for 2016, as I'm moving up to Essential Saver. Now I just need the gap cover (thanks to Myles Mayhew for the advice), and I think my family of 4 should be sufficiently covered.

 

I will see how the year unfolds, on Essential, and then take it year by year from there.

[Grebel]

More than likely switching from Classic Delta Comp to Classic Priority. (ALMOST went up to Classic Comprehensive for the extra MSA.... )

 

Happy with the Classic structure and now that I have Gap Cover I should be fine for any hospital visits. I'll be saving almost R1300 (in my pocket). MSA is a bit less but I'll top up with a small monthly saving account.

 

It's all about managing your funds at the end of the day. Discovery give me R20k up front and I need to stash the "shortfall" over I am guessing 8 month before it's finished.

 

Let's see how it goes.....

[Skylark]

yeah, it's standard with all med aids that only cover hospitalisation. Only exception is Momentum on their Custom option, but even then you're paying for it and they'll only cover the cost of the x ray.

 

Essentially, you need to have day to day benefits if you want ANYTHING that isn't considered as "in hospital" - ie: you're booked in and you have that little membership bracelet on you.

 

You may like the option they're putting out next year... It's like the coastal core, but it has cover for MRI & CT scans. Network hospitals (one of which is C Berg)

 

Attach that to Complimed's new gap cover product which gives you cover for casualty / emergency room benefits, and you're sorted.

What's that complimed offering going to cost?

[Captain Fastbastard Mayhem]

What's that complimed offering going to cost?

R 200. It's built in to all their options, so the base option goes from R 150 to R 200 as of 1st Jan. 

 

Their claims over the last year have been huuuuge. They've paid out 18% more than their premium takings were... 

[Skylark]

R 200. It's built in to all their options, so the base option goes from R 150 to R 200 as of 1st Jan.

 

Their claims over the last year have been huuuuge. They've paid out 18% more than their premium takings were...

And for the R200 Base offering what emergency room cover/scans are included?

[Captain Fastbastard Mayhem]

And for the R200 Base offering what emergency room cover/scans are included?

Just casualty cover - I'll know more when they give us the documentation & tech specs, which will happen (should happen) tomorrow. Right now, all we have is a description. Meeting with the rep tomorrow. 

 

The Scan cover is for co-payments that you'd normally have to pay from your own pocket, or MSA. 

Edited November 12, 2015 by Myles Mayhew

[M L]

Is there a verdict on Fedhealth vs Discovery vs Momentum?

 

Edit: Obviously not trying to compare specific options - just referring to general experience.

Edited March 10, 2021 by M L

[ChrisF]

Is there a verdict on Fedhealth vs Discovery vs Momentum?

 

Edit: Obviously not trying to compare specific options - just referring to general experience.

Been with Discovery for almost 20 years. The odd issue, but ovetall good experience.

 

 

Know different families that moved from Fedhealth to Discovery. Minor differences, and different reasons, but in each case the Discovery package was just that bit better.

 

 

The way the packages are structured it is VERY difficult to do a direct comparison ....

 

 

At one stage Fedhealth covered certain blood tests from the "risk portion", not the savings ... for a select group of clients that was a decider. Discovery has excellent extended chronic benefits , which may sway certain clients ...

 

 

 

I cant comment on Momentum.

 

 

Ultimately only a good broker can analyse YOUR needs and guide you to the correct package for you ...

 

 

 

Maybe rather ask for references for good medical aid brokers in your area

[M L]

Been with Discovery for almost 20 years. The odd issue, but ovetall good experience.

Know different families that moved from Fedhealth to Discovery. Minor differences, and different reasons, but in each case the Discovery package was just that bit better.

The way the packages are structured it is VERY difficult to do a direct comparison ....

At one stage Fedhealth covered certain blood tests from the "risk portion", not the savings ... for a select group of clients that was a decider. Discovery has excellent extended chronic benefits , which may sway certain clients ...

I cant comment on Momentum.

Ultimately only a good broker can analyse YOUR needs and guide you to the correct package for you ...

Maybe rather ask for references for good medical aid brokers in your area

Thanks for the feedback.

 

Have talked to Fedhealth and Momentum and their call centres aren’t very well informed about the options they offer - even less so for the reward programme, so maybe a good broker would be more useful.

 

I decided to do the work and go through each of the options I’m interested on my own - as in read the entire brochure to understand extactly what you’re getting for your money.

 

I would imagine that between the big providers there wouldn’t be too many issues - they’re all reputable.

Edited March 10, 2021 by M L

[ChrisF]

ML worth noting that the SA Medical Council put LOTS of rules in place ....

 

One of these means that each and every medical aid premium already includes your broker fee ...

 

No need to suffer through a call centre !

 

 

Have a sit down with your broker .... a good broker starts by asking a range of questions, aimed at determining your familie requirements, from chronic to hospital to specialists etc etc ....

 

This is the only way to determine which package provides best bang for your buck.

[M L]

ML worth noting that the SA Medical Council put LOTS of rules in place ....

 

One of these means that each and every medical aid premium already includes your broker fee ...

 

No need to suffer through a call centre !

 

 

Have a sit down with your broker .... a good broker starts by asking a range of questions, aimed at determining your familie requirements, from chronic to hospital to specialists etc etc ....

 

This is the only way to determine which package provides best bang for your buck.

 

Didn't know - thank you for this!