By Riaan Reay | November 13, 2019

Let me start by saying that in these financially challenging times one of the scariest choices is to choose your medical aid option for next year.  Let me start my first ever blog with a story, and in this story, I hope that one of your scariest choices becomes a little easier.

Beginning with a short story.  In my first year at university, we had a lecturer who said that we as students should remember one thing: medical expenses are a grudge purchase.  For instance, skydivers like to skydive, but they hate the insurance premium on their lives (their grudge purchase).  Every sport has its grudge purchase.  Why then is it this life insurance a grudge purchase?  The reason is simple: you want to enjoy the sport and be safe, without the cost factor to your family.  The same is true with your medical aid cover (as mentioned by my lecturer).  You and your loved ones want to be safe.

Considering my lecturers’ words, it is that time of year again, where we all need to finalize our medical aid option for 2020.  What will make our grudge purchase worth our while?  The question then is, what option should you choose for your medical aid in 2020?  If you have no idea on which medical aid
option you should be for next year (2020).

You are not alone.

Now let us start by using the figures of the three biggest medical aids in South Africa, namely Discovery Health, Bonitas and Momentum.  The average medical aid contribution increase (for 2020) will be 9.2% for Discovery Health, 9.9% for Bonitas and 8.2% for Momentum. Just remember this is the average increase throughout all their options.

You might now consider one of five choices.

One, upgrade because you paid in out of pocket than expected.

Two, downgrade because you did not use your medical aid completely.

Three, you stay on your current option.

Four, you cancel your medical aid.

Five, emigrate (#imstaying).

Honestly, all these options are purely based on emotion.

Let me start by giving you free advice.  Ask your pharmacist (advice in the pharmacy is always free).  If your current level of health is to continue (which my wish is for all, increased wellbeing), then this is the steps to follow.

Step one, calculate your total medicine expense (ask your pharmacy to give you a printout of all your medicine-related expenses for the last financial year).

Step two, calculate your medical aid contribution (contribution to savings specifically).

Step three, calculate whether you have an excess of funds left in the medical aid savings account or did you have to contribute out of pocket (and what the value was).

Now the fun starts.

It is important to note (here) that most medical aids are non-traditional medical aids.  This means that you have a savings portion that covers all medical expenses such as the following: MRI and CAT scans, blood tests, doctors consults, dentistry, medicines and medical devices not specialized such as prosthesis when claimed from the out-of-hospital benefit, but is included in the in-hospital benefit).  Each medical aid has its own brochure with specific lists.

What my recommendation would be will be determined by yourself, by the way, you answer the following three questions.  Just remember that I am a pharmacist with free advice and not a financial advisor who always charge fees.  Financial advisors will be a topic for another day.

Maybe before I start with the first question, I would like to recommend the following suggestion: I suggest that if you have a hospital, specialist, doctor or pharmacy that you prefer then to start here.  If this service provider (hospital, specialist, doctor or pharmacy) is on the list then select the option that includes that hospital, specialist, doctor or pharmacy.

Question one, do you mind going to a network hospital?  If not, then look at the hospitals in your medical aid list of preferred providers, or network list (such as Discovery Keycare and Delta options, Momentum Custom and Bonitas BonFit, BonEssential and BonCap).  If yes, then your premium would be considerably higher (such as Discovery Classic Saver, Momentum Custom, Bonitas Standard and Primary).

Question two, do you require a large savings amount?  Just remember that the savings amount is given to you at the beginning of the year and gets depleted while you keep on paying the premium.  Here I would recommend that you select an option with a lower contribution to the savings account and then pay out-of-pocket when it is done (Discovery Essential Saver).  This helps to keep your monthly premium at a more affordable level while you don’t pay the large premium when the savings account runs out.  The only negative side is that you have a smaller savings account.

Question three, do you use more than the savings account and the threshold amount of your medical aid?  If you do, then you can select the option with the above threshold benefits (Discovery Classic Priority, Executive or Comprehensive, Momentum Extender, BonComprehensive).  I would only recommend this for smaller
families or older individuals that have more than average medical aid expenses.

Just another thought is this; have you ever thought to split up the family members into perceivably healthier (or lower risk members) and perceivably unhealthier (higher-risk individuals, or if you are planning a pregnancy etc.)?  This could work well if you don’t have a company contributing towards your medical aid, and even more so if you are on a lower income bracket.

As a pharmacist I often hear that the Discovery Keycare option is not worth anything,  I always tell their members that this is the best option given that there are no co-payments if the doctor prescribes according to a formulary list (urge your doctor to prescribe accordingly) and if you visit the network hospitals.  My own granny was on this option and she never had any co-payments after hospital visits.  All her chronic medicine was also paid because it was on the formulary.  She lived until she was 90 years old.

Please don’t be scared, just read the detail, ask about the detail (pharmacists give it for free) and then choose the best cover for you and your family for 2020.

I hope that this information was informative.

Please feel free to ask your pharmacist for advice or e-mail me at riaan@pharmacistinmypocket.com.

Best wishes for 2020.