Belonging to a medical scheme is expensive ‒ and it becomes more expensive every year. The average family pays R6 000 or more each month for their medical scheme premium, yet Andre Jacobs, author of Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently argues that you may actually be overpaying, simply because you do not understand your medical scheme in detail.

In this podcast, Maya and Andre discuss the importance of understanding the fine print of your medical scheme, and what to do if your scheme will not cover certain expenses.

According to Jacobs, research shows that when it comes to appealing decisions of medical schemes, only 45% of people receive decisions in their favour.

“In fact, failing to understand their scheme can cost members more than R20 000 a year,” he says.

The book contains 25 chapters that explain everything from the rights and obligations of both medical schemes and their members, to the types of benefit options and how to know which one is best for you.

Understand your medical scheme terms and wording

The book provides a glossary of the many terms that are often misunderstood, such as “waiting periods”, “hospital reimbursement rates”, “unlimited” in-hospital cover, “co-payments”, “deductibles” and many more.  It gives several examples to further help explain this complex subject.

It also contains a chapter entitled “50 Tips to manage your medical scheme effectively”, which provides invaluable advice about how to select your scheme and benefit option, how to avoid the common major pitfalls, and how to use your benefits wisely and effectively.

Jacobs believes that by applying the lessons laid out in the book, medical scheme members can reduce their health expenses by at least 10% per annum. And in today’s economic climate, with rising interest rates and inflation taking its toll on our household budgets, every little saving counts!