igg Posted July 15, 2015 Posted July 15, 2015 An example is to ask your doctor/specialist if there is an early settlement discount for out of hospital treatment/consultation. Most of them will reduce their bill if you settle on the day. You then submit the claim and get paid out of your med savings. Cash in your pocket. Your MSA lasts longer. I saved R800 off a R1700 specialist bill because I asked the question.... The MSA benefit is an up front savings account that is ALL available from Day 1. It is your responsibility to manage it. You don't need it and you can fund that part yourself if you really want to. I like to know that I have all of it up front... helps me sleep better at night I've always preferred to fund these things out of my pocket. So instead of paying R500pm into MSA. I can just allocate R6k from savings. This way I earn interest on the money instead of the medical aid. In reality the money is sitting in my access bond reducing the interest there. I pretty much always pay immediately, I've never tried my luck asking for a discount on immediate settlement though.
Grebel Posted July 15, 2015 Posted July 15, 2015 I've always preferred to fund these things out of my pocket. So instead of paying R500pm into MSA. I can just allocate R6k from savings. This way I earn interest on the money instead of the medical aid. In reality the money is sitting in my access bond reducing the interest there. I pretty much always pay immediately, I've never tried my luck asking for a discount on immediate settlement though. Whatever works for you at the end of the day
cfcjim Posted July 15, 2015 Posted July 15, 2015 it's most probably down to the fact that they're not governed by the short / long term insurance acts - they're governed by the Council of Medical Schemes. Health Insurance is that product you buy from those other providers governed by the short term insurance act, and pay you an amount per day you spend in hospital (they try to market themselves as Hospital Plans, and then have a disclaimer "Not a Medical Aid" at the end) So no, it's not them, it's just what they're called. Yes, it is a type of insurance, but it's not your traditional insurance where the premium is determined by your risk factors. It's a medical aid plan... I appreciate and understand the explanation. They still should not be called Aid, they are for profit organisations which are insuring you against medical expenses; ergo, insurance companies. I really should climb down from this horse......
Captain Fastbastard Mayhem Posted July 15, 2015 Posted July 15, 2015 (edited) I appreciate and understand the explanation. They still should not be called Aid, they are for profit organisations which are insuring you against medical expenses; ergo, insurance companies. I really should climb down from this horse......No, they're not. A med aid is not allowed to show a profit - any additional funds over and above the administration fees (paid to the administrative arm of a company, sometimes a different company entirely) and claims, goes straight to their reserves, which they are legislatively bound to keep at a level above 25% of the entire annual contributions. The administrative company (which administrates the claims, payments, commissions, marketing etc) CAN show a profit. But it's a completely separate entity to the med aid itself. Med aid is simply a moerse large stokvel. You pay in. Your payments are used to cover claims and boost reserves, if necessary Adminstration charges are levied by whichever company administers the med aid (Discovery, Momentum, etc all have their own administrators, and sometimes administer other medical aids as well) No profit within the med aid itself. Edited July 15, 2015 by Renaissance Man
marko35s Posted July 15, 2015 Posted July 15, 2015 No, they're not. A med aid is not allowed to show a profit - any additional funds over and above the administration fees (paid to the administrative arm of a company, sometimes a different company entirely) and claims, goes straight to their reserves, which they are legislatively bound to keep at a level above 25% of the entire annual contributions. The administrative company (which administrates the claims, payments, commissions, marketing etc) CAN show a profit. But it's a completely separate entity to the med aid itself. Med aid is simply a moerse large stokvel. You pay in. Your payments are used to cover claims and boost reserves, if necessary Adminstration charges are levied by whichever company administers the med aid (Discovery, Momentum, etc all have their own administrators, and sometimes administer other medical aids as well) No profit within the med aid itself. Couldn't possibly be owned/run by the same or related people though.No, Never. Captain Fastbastard Mayhem and cfcjim 2
lerouc Posted July 15, 2015 Posted July 15, 2015 Does anybody have a recommendation for Gap Cover? I use stratum, never had a claim until beginning of this year where my wife had her wisdom teeth pulled. total bill came to just over 30k for 2.5 teeth. The doctor and anesthetist were both contracted out so my medical aid didn't cover everything i ended up paying a total of ZERO rand for the whole thing. i always thought that a gap cover was a waste as i only got it as my wife has some cancer in her family and the medical aid we were on didn't have a very good cover but now after paying a couple of years gap cover I am actually in debt with them as i claimed more so its a win for me and they will have me as a client still for a good couple of years. Grebel 1
marko35s Posted July 15, 2015 Posted July 15, 2015 How much is gap cover?Starts from just north of R100 pm and up.Well worth the cost.
worriesnot Posted July 15, 2015 Posted July 15, 2015 I use stratum, never had a claim until beginning of this year where my wife had her wisdom teeth pulled. total bill came to just over 30k for 2.5 teeth. The doctor and anesthetist were both contracted out so my medical aid didn't cover everything i ended up paying a total of ZERO rand for the whole thing. i always thought that a gap cover was a waste as i only got it as my wife has some cancer in her family and the medical aid we were on didn't have a very good cover but now after paying a couple of years gap cover I am actually in debt with them as i claimed more so its a win for me and they will have me as a client still for a good couple of years.you don't have kids do you?those little munchkins running around depletes our MSA within a few months, then have the self payment gap to close, and then cover starts again.before having children I was "meh, medical aid" - always had it but never used it.now, totally different story all together. oh, and gap cover is awesome as well Bobbo_SA 1
Grebel Posted July 15, 2015 Posted July 15, 2015 I use stratum, never had a claim until beginning of this year where my wife had her wisdom teeth pulled. total bill came to just over 30k for 2.5 teeth. The doctor and anesthetist were both contracted out so my medical aid didn't cover everything i ended up paying a total of ZERO rand for the whole thing. i always thought that a gap cover was a waste as i only got it as my wife has some cancer in her family and the medical aid we were on didn't have a very good cover but now after paying a couple of years gap cover I am actually in debt with them as i claimed more so its a win for me and they will have me as a client still for a good couple of years. Recently signed up with Stratum. On the Elite policy.
Bobbo_SA Posted July 15, 2015 Posted July 15, 2015 I went years without a medical aid. Fortunately never needed one for myself. But there is some level of anguish when your loved one needs medical assistance... In anycase, have a medical aid now. Went to casualty on saterday - my laaitie decided to split his finger with a hammer. He needed stitches. The doctor couldn't even spell the word "hammer". This was at a Netcare. His rendition "harmer"... (tried to upload photo of the guy's spelling, file to big - using tapatalk) Medical aid will not ensure that you get the sharpest pencil Dr we got also at a Netcare facility actually wrote that my son bit the dog rather than the other way around. Makes you wonder what they do for those 7-10 years.
lerouc Posted July 15, 2015 Posted July 15, 2015 you don't have kids do you?those little munchkins running around depletes our MSA within a few months, then have the self payment gap to close, and then cover starts again.before having children I was "meh, medical aid" - always had it but never used it.now, totally different story all together. oh, and gap cover is awesome as well Yeah spot on! Recently signed up with Stratum. On the Elite policy. Think we on the comprehensive...not exactly sure.
JJDT Posted July 15, 2015 Posted July 15, 2015 My 2c about medical aid. It goes beyond just doctors and hospitals. You also need to look at medical devices as such.Just a recent scenario: the guy whose leg was munched by a shark a few weeks ago. His doctors, specialists, hospital bills were payed(even just on a hospital plan) but now he needs a "new" leg to stand on . These prostetic devices are not cheap and the medical aid will cover most if not all of the costs.I currently use hearing aids and my daughter as well and these things are expensive, a basic Phonak hearing aid is about R19k. Without medical aid I simply can not afford these devices, I do not have full hearing loss but 50% to 60% and these devices sure makes life easier. So during the last 4 years I have used about R70k on these devices with only minimal expenses from my pocket. To summarise these days a medical aid is just a must. Bobbo_SA 1
igg Posted July 16, 2015 Posted July 16, 2015 Yeah, you do that. Just be sure to check PMB coverage. It gets murky there, but make sure that your broker's chosen one covers it. Even though the Med Aid shouldMy broker deals with Turnberry for gap cover. The basic cover with 500% medical aid rates and R5m travel cover starts at R135pm. It goes up from there with added stuff like co-payment cover for admissions/out-of-hospital scans, cancer benefits, out-patient/casualty cover for accidents (I wonder if crashing my MTB is considered an accident), etc..
Captain Fastbastard Mayhem Posted July 16, 2015 Posted July 16, 2015 My broker deals with Turnberry for gap cover. The basic cover with 500% medical aid rates and R5m travel cover starts at R135pm. It goes up from there with added stuff like co-payment cover for admissions/out-of-hospital scans, cancer benefits, out-patient/casualty cover for accidents (I wonder if crashing my MTB is considered an accident), etc..Yep. Pretty much the standard cost, and 500% is the standard level. R 5m travel cover is new though. Don't see many offering that.
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