Consultation: Before you agree to treatments, discuss with your doctor whether they are covered by the scheme rules. Picture: 123RF
The only way to avoid this is to understand and play within the rules, but many members are blissfully unaware of them, Victor Crouser, the head of health care in the coastal regions at Alexander Forbes Health, says. The stated self-payment gap could be quite wide — anything from R1,408 for an adult member to R18,800 and there are different rates for adult dependants and children on each option.
In addition, if you buy R100 of over-the-counter medicines together with R450 of prescribed medicines, the scheme may pay the claims in full from your savings account but would exclude the R100 over-the-counter medicine when determining the claims that count towards threshold. Rules differ from scheme to scheme, but if any of these rules apply, be aware that they could affect your self-payment gap:
Your scheme applies copayments for certain benefits and these can be paid from your medical savings account. Copayments will not, however, count towards threshold. Crouser says that if you rarely access your above-threshold benefits, you may be overinsured and may be able to find better value on a different option.
V/good piece. I’m on a premium scheme. In some respects really great but rules are changed and amended with self payment issues - (yes you can find it in fine print) in an effort to avoid payment. There has definitely been a mindset change. Pity because I really rate the co