How can I get advice on my medical coverage?

A medical plan cannot prevent you from applying for plan membership if you are not using the services of a broker, but using one is likely to be beneficial.

And it’s likely that seeking advice won’t impact costs for you, because medical plan advisors are paid for by medical plans.

A good medical diet advisor should:

  • Make sure you have adequate coverage from a medical plan and don’t confuse a health insurance product with medical coverage.
  • Saves you the hassle of researching numerous programs and their options to find the right one, and provides valuable information that you, as an ordinary consumer, may not know.
  • Conduct proper due diligence on any medical plan recommended to you to ensure that the plan is financially sound and well managed. He or she should also keep you informed if this changes.
  • Assess your health needs based on your medical expense history, your and your family’s health status, and your future health needs. This may include, for example, future costs if you are planning to start a family or if you are anticipating a medical procedure. Your broker should reassess this if your health or family situation changes.
  • Identify the appropriate options in the recommended patterns.
  • Work out the cost of joining the medical plan – taking into account any late joining penalties you may pay – and check with you if this is affordable. The late enrollment penalty is a continuing penalty applied to health insurance scheme contributions when a member joins a health insurance scheme after age 35, either for the first time or after a break. of affiliation. The penalty applied depends on how long the member has previously been a member of the plan.
  • Keep you informed of any changes in options or benefits at least once a year and let you know if these changes are worth changing plans or options.
  • Liaise with the scheme on your behalf when your claims are unpaid or in the event of a dispute.
  • How to access chronic medicine.
  • Indicate the main exclusions or limitations of benefits that you should be aware of.
  • Help you through the application process, highlighting important medical history details you need to declare.
  • Let you know if you would benefit from gap coverage. it’s a short-term insurance policy that covers the difference between what your medical plan pays and what a doctor charges to treat you in hospital. Some policies also cover shortcomings in oncology benefits and treatment of the injured.

A good advisor will also tell you how the option works, including:

  • Any hospitalization limits or other benefits for expenses associated with critical illness or hospitalization.
  • How your day-to-day healthcare costs will be covered;
  • Whether you must use a network or specified list of hospitals, and which network of physicians you must use for minimum prescribed benefits and other benefits. These are benefits a plan must, by law, provide, including coverage for all emergencies, 271 life-altering conditions and 26 common chronic conditions.
  • Explain waiting periods that may apply. These are periods during which you are not eligible for a policy or medical plan for all or part of the benefits.

Verify that your broker is legit

The Medical Schemes Act states that medical scheme brokers and the brokerages they work for must be licensed by the Medical Schemes Council.

The board verifies that brokers are fit for the job and have the necessary experience to give advice.

Medical scheme brokers are also subject to the provisions of the Financial Advice and Intermediary Services Act and therefore must also be licensed as a Financial Services Provider (FSP) or act as a representative of a licensed FSP.

Your broker must also have a brokerage agreement with any medical plan they recommend you join, and there must be a written service level agreement between the broker and the plan.

In order to sell you a health insurance product, such as gap coverage, a health care broker must be licensed as a financial services provider capable of advising you on short-term insurance policies.

What does advice cost

The advice your broker gives you about joining a medical plan is usually covered by your plan. The amount your broker can be paid out of the scheme is set at 3% of your contributions up to a maximum monthly rand amount which is prescribed each year – currently just over 100 rand per month.

A broker may also be paid an additional amount agreed upon by you or your employer.

If your medical plan broker stops providing service to you, you may notify the plan that you no longer want the broker’s services and the plan must immediately stop paying the broker.

If you purchase gap coverage insurance on the recommendation of a broker, the broker may charge a commission of between 5% and 20% of your premiums. This is regulated by the long and short term insurance laws.

You should be advised of this commission when you receive a quote from the broker.

Advice for choosing a broker

Brokers must enter into a contract with a medical plan before they can advise you on that plan. Ask how many contracts your broker or brokerage has with the less than 20 open medical plans. Your broker should be able to recommend at least three. Most A plan whose membership is restricted to employees of an employer, industry, or members of a profession.” style=”color: rgb(0, 175, 173); cursor: pointer;”>restricted medical plans do not use brokers or brokerages.