How to Review Your Medical Plan -A Step-by-Step Guide

Our needs change as we age, and so do medical aid plans.

One of the most powerful things you can do for your retirement healthcare budget is review your medical aid plan every single year.

Most South Africans stay on the same plan for years — even decades — out of habit or inertia. But your health profile changes, your family situation changes, and the plans themselves change.

An annual review could save you thousands of rands or ensure you’re properly covered before a health event that costs you far more.

This series was written specifically for you — whether you’re five years from retirement or already enjoying your years of freedom. It is practical, plain-spoken, and South African. No jargon and no advice. Just plain information you want to know for your own well-being.

This is part 10 about: How to Review Your Medical Plan -A Step-by-Step Guide.

Please read the DISCLAIMER from the link near the bottom of the page.

When to Review Your Plan.

The annual open enrolment period, typically October to December for changes effective 1 January, is the ideal time to review.

But you should also review your plan when:

You retire and lose your employer subsidy,
You or your spouse is diagnosed with a new chronic condition,
A dependent leaves the scheme,
You experience a major unexpected medical cost that your current plan didn’t cover adequately.

Your 5-Step Annual Review Process

Review last year’s claims: Pull your annual claims summary from your scheme’s app. How much did you claim? Did your savings account run out? How many co-payments did you pay? This tells you whether you’re over-insured or under-insured.
Assess your current health needs: Are you managing any new chronic conditions? Have you had surgery? Do you see specialists regularly? Your health profile this year may be very different from when you last chose your plan.
List the benefits that matter most to you: Identify your five most important benefits: hospitalisation, specific chronic conditions, oncology cover, dental, optometry, or physiotherapy. These are your non-negotiables.
Compare at least three plans against your list: Use an independent comparison tool or speak to a registered medical aid broker. Compare plans on your five non-negotiables, not just the monthly premium. A cheaper plan that requires a R10,000 co-payment every time you’re hospitalised is not actually cheaper.
Check the hospital and specialist networks: Before you commit to any plan, check that your preferred hospital, your GP, and any specialist you see regularly are in the network. Network restrictions are the number one cause of unexpected bills.

How to Review Your Medical Plan

The best you can do to review your medical plan is by using a Medical Aid Broker.

A registered medical aid broker is accredited with the Council for Medical Schemes and is paid by commission from the scheme — meaning their service costs you nothing directly.

A good broker knows the plans intimately, understands which schemes are best for specific health conditions, and can save you hours of comparison work.

For retirees navigating the transition from employer cover to private cover, a broker can be invaluable, and it is highly recommended that you make use of a broker.

💡 KEY INSIGHT: Ask any broker you engage: ‘Which scheme pays you the highest commission?’ A trustworthy broker will answer honestly and explain why their recommendation is still in your best interest. Transparency is the mark of a good adviser.

Next…

This is the last post in the series.

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PS: We are not medical aid brokers or financial advisors and will not try to sell you any medical cover. This series is for informational purposes only.

DISCLAIMER.