Reassess your health plan - how and why you should

It's that time again where you have the chance to change your health plan for the coming year. Remember that, while you can downgrade your health plan at any time, you can only upgrade it to a more comprehensive plan once a year.

This makes it an important task to review your cover annually and check whether it still caters to your changing health, lifestyle and financial needs. Here are four considerations to help you decide whether to downgrade, upgrade or maintain your current healthcare plan:

1. What you're currently covered for
2. Any changes in your health in the past year
3. Your age and that of your dependants
4. The holistic advice of a financial adviser

Here's how to go about the process.

1. Understand your current health plan

It sounds obvious, but the first thing you need to do is understand exactly what cover you have on your current health plan. You'd be surprised at how many people don't read the benefit guides they receive when signing up for a health plan. Here's what you should be clear on:

• What you're covered for: Check your benefit guide to learn what kinds of consultations, procedures and treatments are covered by your specific medical aid plan. The description of your cover is typically split in three ways: cover for hospital admissions; cover for the treatment of chronic conditions; and cover for out-of-hospital, day-to-day expenses.
• What rates you're covered at: Each medical scheme has a rate of reimbursement for healthcare professionals. Your cover for healthcare professionals is typically expressed as a percentage of the medical scheme's rates for reimbursement. For example, if your plan covers healthcare professionals at 100%, the medical scheme will pay your doctor up to the medical scheme rate. If your plan covers healthcare professionals at 200%, the medical scheme will pay the doctor up to two times the medical scheme rate. It's important to always ask your healthcare provider what rates they charge to see if you'll be covered in part or in full.
• What networks apply to you: Some plans use healthcare networks to offer members a lower contribution rate when using healthcare providers on a defined list. This means that within a network, you could be assured full cover at specific GPs, specialists, hospitals and day clinics, optometrists, allied healthcare providers, or pharmacies. Check to see if you're already part of any networks, or whether it's practical to join one. 

2. Do your screenings to be realistic about your health

Next up is to ask yourself whether you feel adequately covered by your current health plan, and consider any potential healthcare expenses. Have you or has someone on your policy developed a chronic condition in the past year, or is there is a family history of a particular condition?

Going for routine annual health checks and preventative screenings can alert you to potential disease risk. These can include anything from basic health measures like blood pressure, cholesterol, blood glucose and weight assessments, to more specific health screenings like a colonoscopy, an HIV test or a Pap smear and mammogram, depending on your age and gender.

It's essential to talk through your results with your doctor. Their professional opinion can help you decide whether or not you need more comprehensive cover.

Remember that many medical aid providers include recommended annual screenings into their Risk benefit, which means you may not have to pay for certain preventive screenings. Find out which ones you qualify for and take advantage of this every year that you can.

3. Consider your age

Another important factor to consider is your age. If you and any of the dependants on your policy are generally healthy and physically active, you can probably get away with more basic cover. But if, for example, you're feeling your greys, you have a chronic condition, or you and your partner are keen to grow your family, you may want to consider more comprehensive cover.

According to Deon Kotzé, Head of Discovery Health, Vitality and Discovery Card Technical Marketing, young children and seniors generally have greater healthcare needs. "Discovery Health data shows that members older 55 make the most medical claims, followed by children under the age of six."

So remember to account for this as you decide whether to amend your healthcare plan. Also consider any changes to the dependants on your health policy in the coming year, such as adding an aging parent or removing a child who's turning 21.

4. Get holistic advice from a Financial Adviser

Many people consider a health plan downgrade due to affordability, but when it comes to cutting down on expenses, you need to consider your finances as a whole - not just your medical aid contributions. If you've reassessed your healthcare needs and find that you need more comprehensive cover, don't shoot yourself in the foot by compromising on your healthcare.

Conducting a very simple financial and medical needs analysis with a Financial Adviser is always beneficial, as they can offer a perspective based on a holistic view of your budget. Good financial advice can help you maintain the cover you need and reduce your expenses in other areas. By arranging your finances according to what you most prioritise (and hopefully your health is near the top of this list), you'll more likely be able to afford medical help when you or a family member really needs it.

Says Kotze, "On a personal note, my family was on a more comprehensive plan when my daughter Clara was younger. But now that she's six, and we make an effort to eat well and stay physically active as a family, our Financial Adviser suggested moving to a Delta plan. Happily, there are healthcare providers on the Delta network located conveniently close to our home. And, as network plans are more cost-effective, what I save on medical aid contributions I now channel into a fund for Clara's future school fees."

So, take the time to understand your options and make an informed decision. If you find any material from your medical scheme confusing or unclear, seek to understand rather than skip over it. Explore their website for more information or ask your Financial Adviser. As the Roman sage Syrus once said, "Good health and good sense are two of life's greatest blessings."