Medical Aid membership is an important subject to be considered. Appropriate medical cover can have a significant financial impact.
Hospital bills can easily be in the range of anything from R23 000 – R100 000. Procedures can also be planned, whereas having a hospital procedure done in a state hospital can take time.
Where a medical aid plan consists of Risk (Hospital Cover) and Day to Day (Out of Hospital expenses), a person needs to manage the savings element in such a way that you have funds available when the need arises. Day to Day limits can easily be used up on over the counter medication, especially when you self-medicate first, and get more medication on a script, therefore having double the amount deducted from Savings.
Always try to pay for over the counter medication first and then claim from the Medical Aid for more expensive medication, or when the need for it arises. Members need to remember that if you do not use your savings during the year it will automatically carry over to the next, therefore spending for the year needs to be planned accordingly.
PW Harvey & Co is contracted to sell the following:
- Discovery Health
- Momentum Health
- Profmed – Restricted
Every scheme, except for Profmed, which is exclusively for post-graduate professionals, is an open scheme, and anyone can join the Medical Aid.
To add to Medical Aids, we also offer Gap Cover with Stratum Benefits. They are underwritten by Constantia Insurance Company Limited and is a short-term insurance product.
The need for Gap Cover has increased in the last two years. It is important to understand that the normal waiting periods will apply (3 months for new applications and 12 months condition specific waiting period). Gap Cover only pays what Medical Aids do not pay, for example; co-payments (may very per plan) for anything over and above Medical Aid rate.
PW Harvey & Co will assist with the submission of applications and removing/adding of dependants. Members need to obtain their own authorisation when required. In case of an emergency, authorisation must be obtained within 48 hours.
Claims need to be submitted within 6 months or it will not be paid. It is the members’ responsibility to make sure that claims are paid, and refunds received. PW Harvey & Co can also assist by contacting the scheme directly.