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Understanding Your Medical Cover – Part Two

19 November 2020

Choosing the right financial cover is important. It becomes increasingly important when we are discussing a subject as vital as medical cover.

In the previous article we looked at a few general FAQs that we come across on a regular basis, in Part Two we explore some more detailed examples.

Schemes do not have authority over which medication to use
Your medical scheme cannot force you to take a particular type of medication. They may encourage you to use a certain medication, but in the end it is up to you. If you choose not to use their recommendation then you will most likely have to pay any difference in cost.

A scheme cannot force you to use network hospitals
Again, they can encourage you to do so, but in the end it is your choice. If you are willing to pay the difference then you can choose to use out-of-network doctors and hospitals. However, they may incentivise the choice by guaranteeing no co-payments if you stay within the network.

Schemes do not take forever to settle claims
Usually, a claim will only suffer a delay if there is required information that is missing. In fact, the scheme has 30 days from receipt of the claim to settle it. If schemes are regularly missing the 30-day payment schedule then they are called to account by the Council for Medical Schemes.

You can put your parents on your medical scheme
If your parents are financially dependent on you, and you can prove it, then they are able to join your scheme as adult dependants.

A medical scheme can terminate your membership
Many people believe that they are entitled to their membership, but there are circumstances under which your membership can be terminated by the medical scheme or insurer. Most notably, if you are unable to pay the monthly contributions, or if you are found guilty of making fraudulent claims, they can enforce this privilege.

While we have covered common queries that we often receive, it’s only natural that this may have raised more questions. If you feel that you may be under some false impressions when it comes to your medical cover then let’s get in touch and clear up any policy incertitude. We want to ensure that you are getting the most out of your medical cover and enjoy the benefits available to you and your family.

Sanlam Life Insurance is a licensed financial service provider.
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