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Moving off your parents' medical scheme plan can be a big step into adulthood. Luckily, selecting a medical scheme plan isn’t as daunting as it may seem.

Having medical aid is essential in ensuring access to private healthcare, which is why understanding the different options available is a vital part of managing your health and healthcare.

What you get with a medical scheme plan

Having a medical scheme plan ensure that all or at least a portion of your medical bills are covered; while also offering you access to a network of doctors, hospitals, and specialists. Medical schemes are also required by law to provide Prescribed Minimum Benefits (PMBs) for a range of conditions. This ensures that you have access to essential healthcare when you need it most.

Choosing a plan – What to consider

While your budget will certainly play a part in your choice, it shouldn’t be your primary concern. In fact, your first concern should be getting the right level of cover required for your healthcare needs.

Hospital plans: This is the most basic option and focuses on in-hospital care. This means you’ll get cover for major medical expenses like surgeries and specialist treatments. However, a hospital plan does not cover out-of-hospital expenses like GP visits and medications, so you’ll pay cash for any out-of-hospital medical expenses.

A hospital plan is ideal for young, healthy individuals who only want cover for life’s big emergencies, but don’t anticipate a lot of GP visits, so they don’t mind paying for those out-of-pocket.

Network plans vs. comprehensive plans: Medical schemes can negotiate better tariffs with some providers, like specialists, GPs and hospital groups. This is called the scheme’s ‘network’ and is offered on a scheme’s network-based options. While being on a network plan means that the list of providers to choose from is smaller, you’ll save on your monthly contribution. A visit to an out-of-network provider will have to be paid fully from your own pocket.

If you want more flexibility when choosing a healthcare provider, a comprehensive plan might be the best option for you. Comprehensive plans provide coverage for both in-hospital and out-of-hospital expenses, including GP visits, specialist consultations, medication, and more. The contributions on comprehensive plans are higher, so you’ll need to consider when choosing a medical aid option.

To see a side-by-side view of multiple Bestmed plans, click here.

Preventative care benefits: Most medical scheme options include benefits that help prevent serious illness or medical conditions, these benefits may include health screenings, flu vaccines, paediatric vaccines, mammograms, PSA screenings and more. Make use of these benefits every year and catch any potential healthcare issues early.

Your savings account: Most options include a savings component. Familiarise yourself with the specifics of your plan, including what is paid from your savings, and what limits or co-payments apply to specific treatments, practitioners, or medications.

Stay in your network: If you’re on a network plan, be mindful to only make use of medical practitioners within your network. This helps you avoid potential significant out-of-pocket expenses.

Selecting the right medical scheme plan is an essential part of managing your health and healthcare needs. Your overall health, budget and specific healthcare needs are all an integral part of your decision-making process.

If you’re a Bestmed member or have never had your own medical aid, you can get in touch with our Sales team to choose your plan and activate your membership.

Call: 086 033 3838

Email: newbusiness@bestmed.co.za