Work out the numbers
Find out how much is contributed to your medical savings each month. By law, this amount may not exceed 25% of your annual contribution. This will give you a starting point to help you 'budget' which consultations, tests, procedures and medicines you really need. Most schemes fund dentistry, laboratory tests, optometry and medicines out of your savings portion.
Many options offer a threshold benefit. Once your savings account has been depleted, you will reach a limit and enter a self-payment gap where you will be responsible for any further day-to-day expenses. On some options, the scheme then starts funding your expenses again once you are through the self-payment gap - known as above-threshold benefits. Remember to submit each claim, even if your savings account has run out, as the amounts still accumulate and you can then qualify for above-threshold benefits subject to further limits.
For common illnesses, such as flu, your doctor may prescribe over the counter medicines as well as antibiotics to treat your symptoms. When you are sick, it is tempting to pay for all your medication on the script from your savings account. However, pharmacies charge a dispensing fee for providing medicine on scripts - even for over-the-counter medicines. This means you could end up paying much more than you would if you bought the medicine off the shelf and paid cash for it, helping your medical savings last longer.
If you are on regular medication to treat a chronic illness - from diabetes to depression - you could qualify for chronic medication benefits. This means that your medical scheme pays for it out of the risk portion of your medical aid and not your medical savings account. Ask your doctor to motivate this and, by completing a simple form, you could save yourself hundreds of rand a month. If you spend R200 a month on a particular medication, you could save up to R2400/year. That money could then be spent on doctor visits or funding other medical costs.
Find out what types of services are funded out of your savings account - such as dentistry, doctor visits and optometry. Consider paying cash for these and ask the service provider for a cash discount - usually between 5-10%. Then submit the bill to your medical scheme so that the amount accumulates towards your threshold. You will pay less for the procedure and still cover yourself for future medical expenses. If need be you can even ask your medical aid to refund you for the payment you made in cash.
Some schemes offer preventative care benefits, these are paid from the risk portion of your medical aid and are not funded from your savings account. Check whether your scheme covers tests such as cholesterol or mammograms. Some schemes believe prevention is better than cure and it is for this reason that they introduce these preventative care benefits, also known as PCB benefits. Also, check whether you are being treated for a condition classified as a Prescribed Minimum Benefit (PMB) as by law, medical schemes are required to cover these from the risk portion of your medical aid and not from your savings.
If you deplete your savings before the end of the year and switch to a new scheme or resign from the scheme, you will be required to repay the difference in savings to the scheme. The amount repayable is your monthly savings contribution multiplied by the number of months left in the year.
