Choosing a medical aid scheme is a big decision and it is important to shop around before signing up for one. You can compare medical aid schemes based on their benefits and rates. However, there are other factors to consider when making this decision.
This article looks at some of those important things to consider when signing up with your medical aid scheme.
Find Out About Network Hospitals and Doctors
Medical aid schemes have agreements with specific hospitals and doctors to treat members. This is called a healthcare service provider network. It’s important to check which hospitals and doctors are in the medical aid scheme’s service provider network before joining.
If you visit a hospital or consult a doctor that’s not part of your service provider directory, chances are you might experience some huge shortfalls and co-payments. In some instances you may suffer the inconvenience of paying from your own pocket, though you can later claim from your medical aid scheme.
Compare Over-the-Counter Drug Benefits
When comparing medical aid schemes, it’s important to consider their terms and conditions on access to over-the-counter drug. Generally, Over-the-counter drugs are excluded on most medical aid packages and if you need them, you may have to pay for them out of pocket.
However, some medical aid schemes may have special arrangements with certain clients to cover over-the-counter medications up to certain amount per year.
Look At The Chronic Medication Benefit Structure.
When choosing a medical aid scheme, it’s important to consider how their chronic medication benefit is structured. Hassle free access to your medical aid benefits ensures that you get the most from your medical scheme. Chronic medication is any drug that is taken over a long period of time to manage chronic illnesses. For example:
- Drugs used for mental health conditions like Hypertension, Cancer, Anxiety and Depression.
- Antibiotics used for long-term infections such as TB and HIV/AIDS.
Examine the In-Hospital, Maternity and Post-Operative Benefits
- Check the hospitals to which the cover is limited. Medical aid schemes will keep members in hospitals that are part of their service provider network. Make sure you get information on this before signing up with them.
- Confirm the structure of maternity benefit and post-operative benefit. You should also check whether these benefits are covered by your medical aid scheme, as some do not provide these services at all and others will only cover some of them (e.g., just caesarean sections).
Look at the Limits on Sub-Limits and Co-Payments
Some medical aid schemes have developed comprehensive service provider networks so that members do not encounter co-payments and shortfalls. Consider how comprehensive their service provider network is before choosing your medical aid scheme.
Another important factor to consider when choosing a medical aid company is their historical performance in terms of claims payments. Some companies have been known to delay or deny payment on valid claims while others pay on time every time. If you’re having trouble finding reliable information about this online, call them directly and ask them questions about it directly!
Conclusion
We hope this blog post has helped you to understand some of the basics of choosing a medical aid scheme. You can use these tips when shopping for a new plan, or when comparing different options available to you. For more information about medical aid in Zimbabwe contact CellMed Health Medical Fund on 08677 200 200, email contactcentre@cellmed.co.zw or contact us through this website (link to be inserted)