With 2022 lurking around the corner (with exactly 10 days to go) , how well do you know your medical aid cover and option?

Here’s a few tips on what to look out for as well as if you are looking into joining a medical aid during the next 10 days.

  1. The distance from your house and or home/work/School to the nearest Emergency Department /Hospital incase of an emergency? (This is important especially in an emergency situation as it might be quicker for you an emergency situation to get there as soon as you can instead of waiting on Ambulance Services)
  2.  Does the closest Emergency Department/Hospital cover your medical aid and option? ( The importance of this strategy is to make sure  that you do not land up with unnecessary bills to settle due to your option not catering/covering the specific hospital and or department)
  3. What does your medical aid /option cover within the Emergency Department and or Hospital and how much do they cover? Do I need to get an authorization number in order to visit the Emergency Department/Hospital? (Gap cover is always a good idea incase your option on your medical aid only covers 100% of admission/procedures . Some Gap covers can cover up and until 500% of the admission/procedures ) Some lower plan medical aids i.e. example Momentum  Ingwe requires an authorization number  in order for Emergency Departments accounts to be settled and paid, always read through the fine lines on your medical aid options.
  4. Does the Hospital/Emergency Department fall within the list of Network Hospitals and Doctors if you are on a Network plan (This list can be requested at any medical aid that you are on network with an they will happily provide you with the network hospitals and Doctors) Some medical aids does give you the option to load your General Practitioner and or Hospital on the Network list should they not be listed.
  5. PMB options (Prescribed Minimum Benefits)  – Always read through your medical aid option on what ”PMB” options they need to cover incase of an emergency and the procedures on applying for PMB cover at the time of emergency. A PMB list can also be retrieved from the Council of Medical Schemes (CMSA) incase you are unsure.

These are only a few detailed tips when looking into 2022 , new options and medical aids, make sure you know what you are covered for and where to go incase of an emergency!


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