Unexpected medical costs can wipe you out financially so insuring for hefty medical bills is an important part of your financial plan. Medical schemes are fairly expensive and have been seen as the preserve of higher income earners. Fortunately medical schemes have introduced medical cover for lower income earners which are based on what you earn.

These plans usually require you to use service providers and hospitals selected by your scheme and will have certain limits, however they still provide reasonably comprehensive cover for some day-to- day medical costs whilst paying for any major medical costs like hospitalisation.

Day-to-day cover typically includes GP visits and basic dentistry such as your annual check-up, cleaning, polishing, fillings, extractions, pain and sepsis treatment and X-rays. You are also covered for eye tests and a pair of glasses every two years. Prescribed medications that are included on the schemes list of medicines will also be covered.

Hospital costs at a network provider are paid for up to a certain limit and covers the cost of giving birth. Your take home medication is usually covered for seven days and some schemes include some cover for rehabilitation.

Although you are required to use the schemes network of doctors and hospitals, the schemes do provide cover for one or two emergency visits to non-network providers a year.

By law the schemes have to cover all 54 prescribed minimum benefits (PMB) which mean they will pay for medication and associated medical costs related to those conditions which include HIV/AIDS, diabetes and hypertension.

The monthly premiums are usually determined by how much you earn and some funds offer lower rates if you select state hospitals over private hospitals.

When selecting a fund make sure you understand the limits and where they apply so that you do not encounter any unexpected expenses. For example some schemes pay for over-the-counter medication if prescribed by the pharmacist while others do not. Some schemes have unlimited GP visits while others apply a limit to 12 per year. All schemes have a limit on hospital cover but this can range from R500 000 to R950 000 a year.

Also make sure you utilise the services offered, for example some schemes offer HIV/AIDS counselling or child care advice for the first 12 months of your baby’s life.

Momentum Ingwe

Momentum Ingwe is aimed at individuals earning less than R9 000 per month and is linked to your income. Premiums start at R397 for an individual earning less than R4900 a month up to R3533 for a family of five where the main member earns R8900 a month. Premiums are around 20% lower if you opt for state hospitals rather than the Ingwe Network of private hospitals.

Discovery KeyCare

Discovery KeyCare is a range of entry level products. KeyCare Plus and KeyCare Core are for people who earn up to R6 250 per month and the premiums per main member are R638 and R511 respectively. Next year Discovery will be introducing KeyCare Access for R450 per month aimed at those individuals who earn less than R3 900. The focus is on primary health care and provides private GP visits, emergencies and accidental trauma in a private hospital, childbirth and care for newborns in private hospitals and elective procedures in contracted network of state facilities.

Fedhealth Maxima EntryZone

Fedhealth Maxima EntryZone is primarily a hospital plan and is not income dependant. Irrespective of income the principle member would pay R883 per month. The plan has limited day-to-day benefits such as only one GP visit per beneficiary a year although it does include preventative screening care such as cholesterol tests and pap smears. Due to the focus on hospitalisation, it provides unlimited hospitalisation at network hospitals. There is post-hospital treatment for up to 30 days and all specialised radiology such as MRI and CT scans are paid by the scheme. You are able to upgrade to a higher option any time of the year on diagnosis of a dread disease or in the case of a life-changing event.

Bonitas BonCap

For individuals earning less than R5 100 per month the principle member will pay R505 per month. A family of four would have cover for R1460. For individuals earning less than R8300 per month the principle member premium is R614 and a family of four pays R1756. The scheme limits hospital cover to R500 000 per year.

The Rolls Royce of medical schemes

On the other extreme, Liberty Health has introduced Prestige, a fully comprehensive medical scheme that covers all your medical expenses from risk cover so you are never faced with unexpected medical expenses. This option is aimed at executives and people who are too busy making money to have the time to worry about medical admin.

Members are assigned their own private consultant who will be available 24 hours a day, 7 days a week and who will attend to their and their family’s needs. They will deploy a nurse to perform preventative screening tests such as basic blood glucose screening, cholesterol testing and blood pressure, all free of charge. Described as the ‘Rolls Royce’ of medical schemes, the premium for a family of four will set you back over R10 000 per month.

How to increase your medical cover by keeping fit

Momentum has changed the way medical schemes incentivize members to remain healthy. Rather than incentivizing members with travel discounts or free movies, Momentum Health’s wellness programme, HeathReturns, allows you to earn more money for your day-to-day savings which means you can lower the cost of your medical cover just by getting active.

Momentum’s HealthReturns programme enables members to earn additional funds to supplement their day-to-day healthcare cover without it costing them anything extra. HealthReturns are paid based on members’ level of activity which are measured based on either gym visits, pedometer steps or fitness assessments.  It is a great way to keep you motivated to keep up the gym regime!

For example if you attend gym 10 times a month you can earn R100 a month. If you pay that into your day to day savings account (Momentum HealthSaver) it would double to R200. As a couple you could increase your medical savings account by R400 a month or R4800 a year. You can use these funds either for regular medical expenses or for cosmetic procedures such as eye laser surgery.

A health assessment  which is paid from the member’s risk benefit, is a prerequisite to earning HealthReturns, as is complying with prescribed  chronic treatment (but only in those instances where a health assessment shows increased levels of e.g. cholesterol).

This article first appeared in City Press