Most medical schemes will tell you that they ensure the health of their members by providing preventative screening benefits that are paid for from the risk portion of the scheme.

What this means is that certain health tests are paid for not by your day-to-day savings, but by the major benefits, or risk portion of your plan. Even a member on a purely hospital plan would have some of these screenings paid for by the scheme.

These can include mammograms, bone density tests, routine dentist visits, pap smears, prostate checks and even contraceptives.

Yet many members are not aware of these preventative screening benefits or the Ts and Cs that go with them.

Last year, because I turned 50, my doctor recommended I do a set of preventative screening tests which included a mammogram and bone density test. I also went for my regular dental checkup along with my children.

I assumed these were covered by the Momentum Health Platform benefits as they are all preventative screenings. Yet when my savings dried up so quickly, I checked and discovered they had been paid from day-to-day savings.

What I had not realised is that Momentum requires a pre-approval before doing screening tests. Had I been informed of this, I would have saved over R6 000.

Momentum, it appears, is one of the few schemes that actually requires pre-approval. Speaking to several large medical health brokers, I discovered that several were unaware of this provision. However, many schemes have fine print you need to be aware of.

Last year Discovery announced its WELLTH Fund – a once-off bonus providing members with additional funds to provide for screening tests during 2023. But again, one has to be aware of the Ts and Cs.

“It is all about activation. In order to qualify for this benefit, every member of your medical aid over the age of two, needs to first undergo a health check at a specific network provider otherwise you will not get a single cent” says Jill Larkan, , head of Healthcare Consulting at financial advisory firm GTC.

Portia Mahlalela, Regional Executive at Alexforbes Health says the schemes all differ on what they cover and some of them require you to use a designated service provider. For example, on screening tests such as cholesterol, blood pressure and Body Mass Index (BMI) some schemes may require you to use a pharmacy such as Dischem or Clicks.

“You would be surprised how much you can get from your medical scheme, but brochures are updated every year and members never read them. They are long and boring. Schemes should do more to encourage screenings by providing regular, bite-sized information to educate members,” says Mahlalela.

To be on the safe side, it is best to speak to your broker before you do a series of tests to find out what would be covered by the risk portion of your plan.

The lesson learnt is that it pays you to fully understand your scheme’s benefits and to make sure you are making the most of its preventative screening benefits. Make sure you read the fine print, because some schemes are more generous than others when it comes to the frequency of screenings as well as what they actually will cover.

This is what you need to check:

Frequency: Some screenings may be available annually, but others may only be paid for every few years. Schemes differ on their frequency, even between their own plans.

What is covered: Some schemes only pay for the cost of the test while others include the cost of the consultation.

Service provider: Some schemes or plans require you to use designated service providers, while others allow you to go to any provider.

Payment limits: There are limits on the amount the scheme will pay, so if the medical service provider charges a rate higher than the scheme’s rates, you may still have a co-payment.

Pre-authorisation: Some schemes (for example, Fedhealth) do not require pre-authorisation. Others (for example, Momentum) do require you to get pre-authorisation.

Unlocking additional benefits: Some schemes provide additional benefits if you complete a health assessment. For example Bestmed, Bonitas, and Discovery all provide additional cover if a health assessment is completed.