Medic Maze

Attempting to decipher the jargon-ridden maze of a medical aid policy is a challenge for anyone. LIANA REINERS reports.

Throw in the word “disability” and it becomes somewhat akin to solving a Rubik’s cube while blindfolded and wearing boxing gloves. The good news, however, is that medical aids in South Africa are fairly advanced and many offer excellent cover for clients with a disability – but you need to do your research to find the one that best supports your particular condition.

Most medical aids in South Africa won’t charge an inflated premium based on disability: if the person is healthy, under the age of 35 and has no chronic illness, the premium should be no different to that of a person of similar age and health who does not have a disability.

The majority of people living with disabilities are as healthy, or more so, than those not living with a disability. The catch, however, is the cost associated with essential equipment, procedures and treatments that can be required. In addition, some people will be more susceptible to accidents, illness and infection – and all of this should be kept in mind when you’re wading through the fine print.

Today, the high costs of any type of medical care mean that medical aid has become a basic necessity. If someone who is already on medical aid should become disabled in some way, most medical aids will cover the associated costs. Even if you decide to change medical aid providers, there should be no waiting period and in most cases the cover will continue uninterrupted.

If, however, a person who is not on medical aid becomes disabled and then joins a medical aid, there is likely to be a waiting period before the medical aid will start covering claims. In most cases they will not cover equipment or medication for a pre-existing condition within the first year of membership – this applies to all conditions and is not purely related to disabilities – but it varies so be sure to check the timeframe when comparing. Keep in mind that certain expenses that are not covered by the medical aid during the first year can often be claimed via tax returns.

The biggest concern for people who join a medical aid only after they become disabled is that medical aids will not pay for any surgeries related to rehabilitation. In the case of persons who were already on medical aid, the medical aid will likely cover the majority of such procedures.

Local medical aids will also not cover any costs related to experimental procedures or treatments that are not yet available in South Africa. They will not pay for overseas medical procedures.

If you have medical aid in place but are still considering overseas treatment at your own expense, it is advisable to discuss this with your medical aid. Most medical aids will not cover expenses resulting from unauthorised procedures and will not accept new clients who have become disabled due to a medical mishap.

So in a nutshell: the sooner you get onto a medical aid the better, but you should take the time to compare the different medical aids and find the one that best suits your needs. If you’re already on medical aid, there is nothing wrong with shopping around to see if you can find more comprehensive cover elsewhere. Just take time to slog through the fine print and remember that you can never ask too many questions.

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