When it comes to securing access to health care, most South Africans just want a medical aid scheme which is straightforward and easy for them to understand. That is exactly what Hosmed medical aid strive to offer to their members. This particular medical aid scheme is available to both the private and public sectors in South Africa. The Hosmed medical aid scheme was first established in the late eighties with the goal of securing health care for civil employees, but it has now grown at a steady rate and now boasts around 34,000 members.
The key thing that most people look for in a medical aid program is a good selection of benefits at an affordable rate. There are three main plans offered by Hosmed medical aid all of which certainly offer a great combination of benefits that do not carry exorbitant premiums.
The Hosmed Step Option
The basic level of medical aid offered to the public is the Step Option which offers admission to any state run medical facility including hospitals, clinics and treatment centres. These admissions do need to be backed with a pre-authorisation slip. The plan also offers a number of high risk benefits including coverage for chronic illness that does not exclude HIV and AIDS. This is something that many other schemes charge a surcharge for, although the Hosmed medical aid do pace several protocols on this cover. However, HIV management cases will only be approved if the patient is a member of the scheme prior to treatment beginning.
The Hosmed Value Option
If the step plan does not seem the right fit, then the mid level plan may be a better option. The Hosmed Value Option offers most of the same benefits that the Step Option does, but one of the main additions is that this particular scheme option offers a very attractive day to day option which covers over the counter medication with a limit of R500 per family or R120 per prescription. Additional cover offered also includes treatment for mental health issues, physiotherapy and alternative therapies.
The Hosmed Plus Option
At the top level of the scale, Hosmed medical aid offer the Plus Option plan. This is the most fully comprehensive plan offered by the scheme. The over the counter medication usage limits are higher with an annual family limit of R850 and a per prescription maximum of R180. The plan also includes cover for prescription medication. There are also some increases in the day to day benefits.
The important thing to keep in mind if you feel that Hosmed medical aid is an appropriate choice for you is that you need to decide what your needs are prior to choosing a plan. This means taking a closer look at the benefits offered and also at the general health of you and your family members.
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One of the up and coming medical aid schemes at the moment is Gems Medical Aid which can offer plans that are a little different to those offered by the more well known plans such as Discovery and Bonitas. Gem medical aid is primarily aimed at providing healthcare to suit government employees. The scheme has five affordable plans which have been created with members’ needs in mind.
Gems medical aid aims to provide members with access to an extensive range of benefits while still maintaining affordable monthly premiums. Gems provides access to quality healthcare to public service employees and low income families. Gems medical aid members can also receive medical care at private clinics, access disease management programs and get emergency care as required. Let’s take a closer look at the plans on offer to Gems medical aid members.
The Sapphire Plan
The Sapphire Plan from Gems medical aid offers members access to a large network of health care providers including pharmacists, dentists and GPs among other services. Plan members do not need to pay any additional fees for treatment and consultations received within this network.
The Beryl Plan
Beryl offers all of the same benefits of the Sapphire plan, but members also have access to some additional benefits including out-of-hospital over, chronic mediation cover, maternity programs, dental cover, HIV/AIDS management, Oncology cover and optometry care.
The Ruby Plan
The Ruby Plan allows Gems medical aid members with an additional level of care. Not only do they get access to care programs for chronic diseases which will provide both them and their families with the necessary support and medical care they need, but the plan also includes a savings account.
The Emerald Plan
With the Emerald option plan members still have to make use of the approved GEM network of health care providers if they are to avoid out of pocket expenses, but using them is not required. It is necessary to seek re-authorisation for hospital visits including out patient visits, physiotherapy and ambulance transport.
The Onyx Plan
The upper level plan offered by Gems medical aid is the Onyx plan which offers members very specialist care programmes to help manage a range of chronic diseases. This includes education about a number of conditions including asthma, diabetes and mental health. There is no requirement for Onyx members to use the GEM network of providers, but doing so will remove the potential for out of pocket expenses.
Pre-Authorisation For Gems Medical Aid Plans
The various plans do require pre-authorisation when it comes to specialist dentistry, physiotherapy, out-patient hospital treatments, MRI scans and CT scans. Ambulance transportation is also a requirement for re-authorisation.
In conclusion, Gem medical aid presents the ideal solution for government employees and low income employees who are looking for quality healthcare at affordable rates while also gaining access to great benefits.
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(Photo credit: Wikipedia)
You may be wondering why having medical aid is so important? Well if you do not have the means to pay for private medical treatment then you are going to have to look at the alternatives. When you do not have a medical plan, you are leaving yourself vulnerable to problems that can arise when you either fall ill or become the victim of an accident that causes significant injury. Without a coherent medical aid plan, such as those offered by Liberty Medical, you are left with not many options. One of the options is to make use of the state funded medical facilities that are provided by the South African government.
Going to a private medical facility and expecting them to treat you is not going to happen if you do not have a medical aid plan in place, and you may well end up having to take out a loan in order to pay for the treatment you receive. All this will do is put you into debt, which is not something that most people would want to contend with, when they are trying to recover their health after illness or injury.
The option that involves relying on the state run health centres is again not a very suitable solution for everyone. This is because the standard of treatment that you can expect to receive in one of the state run medical facilities may not be up to the standards that you were expecting. The health centres can be overcrowded and underfunded and the waiting times have the potential to be enormous, leaving you waiting, weeks or months for adequate treatment.
Because there are so many medical aid providers all offering a multitude of differing medical aid packages, then it can be a bit difficult to negotiate your way through the maze of different policies and levels of cover that they provide.
If you are young, single and of good health, then you may be just looking for a plan that covers you for a stay in hospital, for when the unexpected happens. However, if you are suffering from a chronic illness and you require long-term treatment, then you will need to look for a policy that is more expensive, but which provides you with more comprehensive coverage.
There are plenty of medical aid websites available on the internet and most of them will be able to assist you with providing you with a quote for their specific medical aid packages. However, in order to make sure that you find the right medical aid package that best suits your needs, then you need to compare the pros and cons, and not to mention the cost, of a wide range of different plans.
This will help you to make the right decision as you should not rush in to making a poor decision when it comes to your health and well-being. That is why you should take your time to consider what options you have open to you when it comes to medical aid.
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