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Medical Schemes Explained
Your ultimate guide to use your medical scheme efficiently
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Saving clients 20% of their health expenses within 90 days without changing medical scheme options.
In Conversation With...
Author Andre Jacobs, talks about how to use your medical scheme correctly. Guide, Educate and Protect yourself.
Join Our Newsletter
Subscribe to our free newsletter, where we will keep you informed of the latest developments in the world of medical schemes and related.
Promotional Videos
Saving clients 20% of their health expenses within 90 days without changing medical scheme options.
In Conversation With...
Author Andre Jacobs, talks about how to use your medical scheme correctly. Guide, Educate and Protect yourself.
Join Our Newsletter
Subscribe to our free newsletter, where we will keep you informed of the latest developments in the world of medical schemes and related.
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In South Africa, the high cost of private medical scheme cover means that only 48% of the employed population belongs to a medical scheme – and even this group finds it to be too expensive. The average family pays R6,000 or more a month for their medical scheme benefits, only to later find that they are out of pocket and that they are not covered as they thought they were.
Medical schemes can be notoriously complex for many to understand. When it comes to appealing decisions of medical schemes, research shows that only 45% of people receive decisions in their favour. Indeed, failing to understand your scheme can cost you more than R20,000 a year.
Isn’t it better to understand your medical scheme from day one? This book is an easy to read, step-by-step guide to help medical scheme members understand their medical scheme, and to use their medical scheme offerings efficiently. Applying the 50 lessons learned in this ultimate guide to medical scheme cover can reduce your health expenses by a minimum of 10% per annum.
The book consists of 25 chapters providing you with more than 50 tips on how to use your medical scheme more efficiently and explaining about 70 terms in a language we all can understand. To know more of some of the topics click on the hyperlinks below or just click on the link here to download the book.
My rights
Do you know what your rights are as a medical scheme member? I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently, to the rights of medical scheme members.
The Medical Schemes Act is the most consumer-friendly piece of legislation that there is. We discuss 11 rights that consumers have and 3 obligations. #mymedicalschemerights
Do you know that only 45% of cases that are taken to appeal are decided in favour of the members of medical schemes? This is because members don’t know how to correctly enforce their rights or don’t know what their rights and obligations are.
You can read more summaries of topics, or you can just click on the link here to view the book.
Types of medical schemes
Which medical scheme type will suit you? I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently, to explaining the 8 different types of medical scheme options. #typesofmedicalschemes
Choosing the right medical scheme option will assist you understanding your level of cover better. This understanding will also assist you in choosing the right medical scheme option that best meet your health cover, affordability, and cash-flow constraints.
You can read more summaries of topics, or you can just click on the link here to view the book.
Medical Savings Account (MSA)
Do you know how your medical savings account (MSA) really works? I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to explaining the MSA.
Do you know how your medical savings account (MSA) really works? I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to explaining the MSA.
The MSA is your own funds and not that of your medical scheme. Your MSA is also protected from creditors except in two circumstances. We explain what they are. We also explain how to use your MSA more efficiently. We also debunk the myth that when you resign from a medical scheme that the medical scheme may only pay your MSA after 4-months. #MSA #medicalsavingsaccount
You can read more summaries of topics, or you can just click on the link here to view the book.
Self-payment gap (SPG)
Does the self-payment gap (SPG) and threshold confuse you? I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently, to explaining the SPG, the threshold and the above threshold benefit.
We explain what a SPG is, what a threshold is, what am above threshold is. We also explain the unlimited and limited above threshold benefits. #selfpaymentgap #SPG
Do you know that you can pay twice or more what the contracted SPG is and still not reach the threshold? We explain why this is the case and how you can avoid that some claims don’t accumulate to the threshold.
You can read more summaries of topics, or you can just click on the link here to view the book.
50 Tips
How do you use your medical scheme efficiently? Are there tips?
I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently, to giving 50 (LOL maybe more – read and find out) tips on how to use your medical scheme efficiently. #medicalschemetips
The whole book contains tips on ow to use your medical scheme efficiently, but this chapter details 50 or more tips on how to use your medical scheme efficiently. Just reading this chapter and applying the tips provided can save you tens of thousands of rands a year.
You can read more summaries of topics, or you can just click on the link here to view the book.
Terminology explained
Does the self-payment gap (SPG) and threshold confuse you? I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently, to explaining the SPG, the threshold and the above threshold benefit.
Medical schemes are complex and use their own terminology that is foreign to most people.
I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently, to explaining nearly 70 terms, words and concepts used by medical schemes, administrators, the regulator, and brokers. #medicalschemewords
Understanding these terms and understanding your rights in terms of these terms assist to break down the asymmetry (imbalance) of information. Not only will you, after reading this chapter know what these words mean but you will know how it can impact you and also know what your rights are
You can read more summaries of topics, or you can just click on the link here to view the book.
GAP Cover
I have two questions for you.
1. Do you know what GAP cover is?
2. Do you have GAP cover
I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently, to explaining what GAP cover is, what different benefits there are and what value-added benefits there are regarding GAP cover.
I also explain why the FAIS Ombudsman instructed brokers to advise their clients to take GAP cover and why such cover is one of the best financial decisions you can take.
You can read more summaries of topics, or you can just click on the link here to view the book.
Chronic conditions
Do you suffer from a chronic disease such as elevated hypertension or what we know it as high blood pressure?
I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently, to explaining what chronic conditions are and what your rights are regarding chronic conditions. #chronic
Medical schemes are allowed by law to only pay for certain medication. They call this list of medication a formulary. This said, medicine is not an exact science. We react different to medication and treatment. #formulary #protocolTherefore, medical schemes are compelled by law to make exceptions to lists of medications or formularies. #substitute This is explained in detail.
You can read more summaries of topics, or you can just click on the link here to view the book.
Waiting periods
Do you know what your rights are regarding waiting-periods?
I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently, to explaining what types of waiting periods can be imposed and under which circumstances. #waitingperiods
I also explain why no waiting period can be imposed on so called pre-existing or related conditions.
You can read more summaries of topics, or you can just click on the link here to view the book.
Late-Joiner Penalties (LJPs)
Do you know what your rights are regarding late-joiner penalties?
Do you know that you can be a late-joiner but don’t pay a late-joiner penalty? Do you know that you can be the same age as another person he can have no or a 5% late-joiner penalty and you a 75% penalty?
I dedicated a whole chapter in my book, Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently, to explaining what late-joiner penalties are and how to apply them. #latejoinerpenaltyc
I also explain how you can reduce your late joiner penalty and save hundreds of thousands of rands during your lifetime.
You can read more summaries of topics, or you can just click on the link here to view the book.
