Medical aid

[Red Robin]

I will stay with Discovery as when the proverbial hit the fan a few years in a pretty big way. All medical bills were covered and I stopped adding up after they went above a million. So my experience has been very positive but Discovery might not suit everybody.

[Pooyan]

Dankie Chris, net gou sekermaak, volgens jou opsomming gaan Momentum vir my gesin van 5, R4432 kos, maar my quote vanaf hul makelaar is R3550 (sonder enige chronies en spaar) mis ek iets?

Kronies is ingesluit by Chris se dokument. Kos dus duurder.

Custom opsie | Associated Hospitals | State Chronic beloop R3 567 vir gesin van 5.

[Captain Fastbastard Mayhem]

Dankie Chris, net gou sekermaak, volgens jou opsomming gaan Momentum vir my gesin van 5, R4432 kos, maar my quote vanaf hul makelaar is R3550 (sonder enige chronies en spaar) mis ek iets?

It'd your brokers obligation to go through all of this stuff with you. It's what he gets the commission for.

 

I may have time to look at it tomorrow for you if you wish.

[Captain Fastbastard Mayhem]

Kronies is ingesluit by Chris se dokument. Kos dus duurder.

Custom opsie | Associated Hospitals | State Chronic beloop R3 567 vir gesin van 5.

Yes. That sounds about right.

 

Chronic will always be there. Just the provider that changes.

[TALUS]

It is 02:00 in the morning in Dubai so this will be short.

1) If you have ever asked "who is the best Dr for this...", and then choose a network option - YOU ARE MISSING THE POINT BIG TIME!

2) If you are not on chronic medication now it doesn't mean a thing - statistically it likely that someone in your family will need chronic meds eventually. Do you think that any Fund will be happy to take you on for a guaranteed loss?

3) Please go and physically have a look what it means to get chronic meds from the Public Hospital (EVERY MONTH for the rest of your life).

4)Many Aids will flatly refuse endoscopic or arthroscopic surgery. This means you will get 20y ago's surgery (Profmed and Gems often - occasionally Bestmed)

5) Contact your medical aid on a Saturday afternoon to authorize a procedure for Monday (this happens more than you think). Only Discovery will give you a final answer out of office hours.

6) Gap cover rules have already changed but it is being phased in over 2 years (I think).

7) Several funds force Surgeons to use generic /inferior /old technology. If you are thinking you are saving now - wait until you decide for a procedure that your fund does not want to pay for.

 

All my colleagues (bar one) is on Discovery. All of us deal with this daily.

[ChrisF]

It is 02:00 in the morning in Dubai so this will be short.

1) If you have ever asked "who is the best Dr for this...", and then choose a network option - YOU ARE MISSING THE POINT BIG TIME!

2) If you are not on chronic medication now it doesn't mean a thing - statistically it likely that someone in your family will need chronic meds eventually. Do you think that any Fund will be happy to take you on for a guaranteed loss?

3) Please go and physically have a look what it means to get chronic meds from the Public Hospital (EVERY MONTH for the rest of your life).....

 

The concept of "Network" providers have changed significantly over the last two decades.

 

We are currently on a "Delta" option with Discovery, ie one of their Network hospital plans.  We FIRST checked which hospitals are on this plan.  Panorama Medi Clinic provides all the services we need.

 

Depending where you live this may or may not work for you.

 

It does offer us a massive saving !!

 

 

 

Chronic medication ..... there is a long list of PMB conditions : https://www.medicalschemes.com/medical_schemes_pmb/conditions_covered.htm

 

 

Your medical team and medical aid broker should be able to guide you through the process for this.

 

The "fun" starts when you have a chronic condition that is not on this list .....  Typically the meds/treatment is then covered from your savings plan with the various sub-limits.  Which typically means you need your savings for the family and end up paying your chronics yourself ....  Unless you have one of the better medical aids that will consider an ex-gracia application for cover.

[Captain Fastbastard Mayhem]

And then if you don't have cover for that chronic, you can upgrade at the end of the year. You're not stuck in that med aid for life. Likewise there'd only be a 3 month general wait period if you moved to another med aid company, during which time the 27 PMB chronic conditions would be covered.

 

The change in gap cover rules is for the moment largely immaterial. When it does eventually get implemented then we will reassess

[Tracey8670]

I'm about to change from Discovery to Momentum medical aid mainly becouse its much cheaper and with my fitness and health record I sould be able to get a lot of money back through multiply. Apparently they give more cover as well, but with all the fineprint I'm not always sure you can trust everything the broker say.

 

Anyone else that made the same move and are you happy with Momentum's cover and service? Is multiply as good as it sound?

 

Let me know what you decide !  Am thinking of making the move myself but am very very happy with Discovery Vitality and get LOADS of money back.  I know Multiply offers about R1000 per month per member back - but is this sustainable? 

[daniemare]

Hi All

 

Thought I will mention Sanlam Go cover I recently discovered.

 

Where GAP cover covers only the doctors bill gap, this is excellent cover for accident cover.

 

After my wifes off, and significant damage to her teeth, you quickly realise that there can be some significant GAPs in the cost of implants etc, depending on your plan which GAP cover does not cover.

 

So this is where Sanlam GO cover comes in. App based and bought per day, (eg R10 for R100 000 cover for 24 hours) this payouts will assis in filling the Gaps typical bicycle accidents cause.

 

Being per day is awesome - I buy literally just before a race start - and boom, covered during your ride.

 

Ps, I am not a salesmen, just thought I share

[andydude]

Hi All

 

Thought I will mention Sanlam Go cover I recently discovered.

 

Where GAP cover covers only the doctors bill gap, this is excellent cover for accident cover.

 

After my wifes off, and significant damage to her teeth, you quickly realise that there can be some significant GAPs in the cost of implants etc, depending on your plan which GAP cover does not cover.

 

So this is where Sanlam GO cover comes in. App based and bought per day, (eg R10 for R100 000 cover for 24 hours) this payouts will assis in filling the Gaps typical bicycle accidents cause.

 

Being per day is awesome - I buy literally just before a race start - and boom, covered during your ride.

 

Ps, I am not a salesmen, just thought I share

Whoa stop the lorry.. first there's this thing where funds say we're not paying full. New gap industry is created. Now you're saying that gap cover doesn't cover the gap. Now we have to buy gap on gap, or gap squared?!

[ChrisF]

Whoa stop the lorry.. first there's this thing where funds say we're not paying full. New gap industry is created. Now you're saying that gap cover doesn't cover the gap. Now we have to buy gap on gap, or gap squared?!

Think Sanlam saw a GAP in the market ....

[Captain Fastbastard Mayhem]

Whoa stop the lorry.. first there's this thing where funds say we're not paying full. New gap industry is created. Now you're saying that gap cover doesn't cover the gap. Now we have to buy gap on gap, or gap squared?!

Gap cover is for IN HOSPITAL accounts. I'd imagine that this isn't. Either that or theyre doing a daily version of the normal gap cover.

 

Will have a look at it next week

[stringbean]

As with everything in life you get what you pay for.Yes you may save a few bob here and there but you may also be giving up something huge to make that saving.

Dealing with patients every day I can say that 99% of them DO NOT know exactly what their plan entails.They are also too lazy to find out and read all the small print.

 

Advice:Get a broker,give up your time and let him explain everything to you.

 

Just a side note if you have gone for the preferred provider or hospital plan to save money.Even if the hospital is close to you and convenient you loose the option of having the BEST person operate on you.You can't come on the hub with"I need this operation.who is the best person to do it"

[igg]

Hi All

 

Thought I will mention Sanlam Go cover I recently discovered.

 

Where GAP cover covers only the doctors bill gap, this is excellent cover for accident cover.

 

After my wifes off, and significant damage to her teeth, you quickly realise that there can be some significant GAPs in the cost of implants etc, depending on your plan which GAP cover does not cover.

 

So this is where Sanlam GO cover comes in. App based and bought per day, (eg R10 for R100 000 cover for 24 hours) this payouts will assis in filling the Gaps typical bicycle accidents cause.

 

Being per day is awesome - I buy literally just before a race start - and boom, covered during your ride.

 

Ps, I am not a salesmen, just thought I share

Seems like a pretty cool short term accident cover product.

 

Had a similar experience last year that I'm still paying for: significant damage to teeth and jaw. Only a tiny portion was hospital cover with the rest being specialist which medical aid/gap doesn't cover....

 

https://www.sanlam.co.za/gocover/Pages/default.aspx

[Malpiet]

I dunno hey...I have never ever had a problem with profmed...every now and then I think about switching to capitalise on the incentive schemes etc...but then I look at the core function (being medical insurance) and I just cannot fault them..and quickly dismiss that idea

Profmed is really good but not open to anyone.

[ChrisF]

As with everything in life you get what you pay for.Yes you may save a few bob here and there but you may also be giving up something huge to make that saving.

Dealing with patients every day I can say that 99% of them DO NOT know exactly what their plan entails.They are also too lazy to find out and read all the small print.

 

Advice:Get a broker,give up your time and let him explain everything to you.

 

Just a side note if you have gone for the preferred provider or hospital plan to save money.Even if the hospital is close to you and convenient you loose the option of having the BEST person operate on you.You can't come on the hub with"I need this operation.who is the best person to do it"

 

I have heard people complain Discovery cost me "x-amount" per month .... but they dont even know on which plan they are, never mind the benefits or limits .....  It is the 2nd highest monthly expense for most people, yet people dont bother getting the basic facts ....

 

 

 

 

Sadly it is becoming too expensive to be on an "open" option, ie any hospital.  Fortunately we have a good hospital on our network list, and thus far all our operations were their despite our medical aid network, even before going onto the network option.  But YES, there are some network hospitals I would rather avoid ... so best do your homework !!