Does your medical scheme benefit option match the needs of your age group?
While some health conditions can strike out of the blue, there are some health problems that tend to arise as a result of ‘wear and tear’. The presence of such conditions has a distinct correlation with age, and it is therefore wise to factor in age when making a decision on which medical scheme benefit option will best meet your needs, particularly for such predictable risks, in the foreseeable future.
“There are so many health events that we cannot predict, but certain conditions are definitely more prevalent in particular age groups. For example, data from our membership indicates that the average age for claims on orthopaedic surgery on hips, knees and spinal procedures is 51 to 52 years old,” explains principal officer of Resolution Health Medical Scheme, Mark Arnold.
“It is relatively common for people in their 50s to require such orthopaedic procedures. Similarly, the average age for cardiovascular surgery is 63. Some people may never require these types of procedures, and in some exceptional cases the need may arise at a younger age. In the main, however, it is pragmatic to align your healthcare cover to the common healthcare needs associated with your age group.”
Arnold says it is also worthwhile considering the hereditary health ailments members of your biological family have experienced, as these can also provide some indication of the kind of health events that might affect you. “If you know that your great-grandfather, grandfather, and father all experienced shoulder problems in later life, for example, it would make logical sense to ensure that your benefit option will cover rotator cuff surgery with the surgeon and at the healthcare facility of your choice,” he notes.
“Some medical schemes have agreements with certain healthcare provider networks, which require that members, or members on a particular benefit option, have planned procedures in a network hospital. People often overlook this when choosing their benefit option, but when faced with the need for surgery, they want to go to the doctor and hospital of their choice. If these are not within the preferred provider network, however, the member could face a hefty co-payment.”
Once a year, members are given the opportunity to review their level of healthcare cover for the next year and must decide whether to remain on their existing benefit option or change to a different one. “During this time of year, medical scheme members should consider not only their present state of health, but also take into account the types of age-related and hereditary conditions that may present themselves,” Arnold advises.
“While many people look for ways of economising as they approach retirement, we would advise members to think long and hard before compromising on their healthcare cover. While one does not necessarily see the advantages of a strong benefit option on a daily basis, it certainly provides a great deal of peace of mind to know that you have access to comprehensive cover when you need it. As people age, their healthcare needs tend to grow, and it is therefore advisable to increase – or at the very least maintain – your level of healthcare cover as you get older, as far as possible.”
By law, medical schemes must operate as not-for-profit entities, act in the best interests of their members and provide comprehensive cover for 271 of the most common and serious medical conditions through prescribed minimum benefits (PMBs).
“PMB payments are funded by the main risk pool of a medical scheme, and therefore are available on all benefit options, but it is important to bear in mind that the degree of cover provided may differ considerably if the member does not seek treatment through a preferred healthcare provider, if this is a stipulation of your benefit option,” Arnold adds.
“PMBs should be regarded as a safety net, rather than a cheap healthcare cover solution. While emergency and chronic conditions are covered in the PMB list, there are thousands of other health conditions that can compromise an individual’s quality of life – particularly later in life.
“When choosing your benefit option for the year ahead, it is imperative that you consider the possibility that you might find yourself, or one of your beneficiaries, in need of expensive treatments for non-PMB conditions. After the benefit option change period ends, you are committed to the level of cover you have chosen for the year and must be confident that it will be sufficient.”
Although some health conditions occur without warning or any means of prevention, Resolution Health encourages members to take proactive care of their health through regular health screenings, such as pap smears, prostate checks, and blood pressure testing to name a few.
Resolution Health’s wellbeing and rewards partner Zurreal, through its Zurreal Platinum programme, incentivises routine health checks and exercise through cash-back rewards, which are paid into members’ Zurreal Healthcards as savings towards health-related expenses.
“Leading a healthy lifestyle can go a long way towards safeguarding your physical wellbeing but it cannot provide complete protection against some conditions, including some of those associated with aging, or which may be inherited. Ultimately, we will all require some degree of healthcare and cannot predict when such a need will arise.
“It is certainly worthwhile budgeting monthly towards healthcare expenses in the form of medical scheme cover that is as comprehensive as you can afford, rather than being confronted with steep healthcare bills or co-payments when you are also burdened with the stress of health ailments,” Arnold concluded.