158 replies to this topic Post Order

[Wet Ears]

And this gap cover is for in hospital short falls only - is that correct?

[Stretch]

cptmayhem, on 14 November 2012 - 01:25 , said:

Did u contact them, and someone phone you and go through the process? If so, ur deets were passed to a broker who now receives comm for it.

u are correct - i did go through a broker

[TNT1]

cobuswes, on 14 November 2012 - 06:34 , said:

I dont think CAMAF is an open plan though. Good plan

CAMAF is without a doubt the very best med aid I've ever been on, but as you say, they are a very closed and very specific plan. If you ever can get on it, do so.

[Christopher Brunsdon]

cobuswes, on 13 November 2012 - 10:43 , said:

Also consider the "the other side's view". If you need urgent attention - can your medical aid be contacted after hours to auth or even decline a request (eg XR). ...

We have gotten auth from Discovery at 2am in the morning on more than one occasion and on weekends as well. What we found was the relationship your hospital has with the medical aid and your details on file determine your experience and how quickly they get the paper work done.

[geraldm24]

durbanjacques, on 14 November 2012 - 08:53 , said:

MRIs are not cheap and the hospital refuses to do them before they are paid.

out of interest, how much does a MRI cost??

[cpt armpies mayhem]

geraldm24, on 16 November 2012 - 08:24 , said:

out of interest, how much does a MRI cost??

between 8k & 20k depending on the hospital & the scan density / area.

[Blindspot]

All the medical aids refer to "100/200/300% of Scheme Rate".
Is the "scheme rate" for all medical aids different or is it the NHRPL rate?
If it is different then 200% for the one scheme can be equal to 300% for the other or how does it work?

[SA MTB Tours]

Go have a look at Oneplan Best value for money!!

[cpt armpies mayhem]

Blindspot, on 22 November 2012 - 03:36 , said:

All the medical aids refer to "100/200/300% of Scheme Rate".
Is the "scheme rate" for all medical aids different or is it the NHRPL rate?
If it is different then 200% for the one scheme can be equal to 300% for the other or how does it work?

The "scheme rate" is different for each med aid, but is more or less the same give or take a few rands/cents. They are all loosely based around the NHRPL, but not exact measurements of.

And no, one's 200% cannot = another's 300%.

[Blindspot]

cptmayhem, on 22 November 2012 - 04:36 , said:

The "scheme rate" is different for each med aid, but is more or less the same give or take a few rands/cents. They are all loosely based around the NHRPL, but not exact measurements of.

And no, one's 200% cannot = another's 300%.

Thanks

[ricochet_rabbit]

cptmayhem, on 14 November 2012 - 08:29 , said:

Oh, Grumps - with Alzeimers, absolutely! But then that is a PMB, and they should be receiving a certain amount of basic benefit that isn't paid from the MSA.

Either way - to advise a couple, one of which has Alzheimers, to go on to a Coastal Saver Plan, is just wrong. They would need the higher echelon of care that a Comprehensive plan would offer (I don't like Priority - I've done the calculations before and it works out more beneficial to put the difference between Coastal Saver & Essential / Classic Priority into an Investment to attract growth)

Bottom line - bad advice. But then maybe there was a monetary limitation, so that needs to be taken into consideration as well. At the end though, it should have been explained properly, and not treated as a fit n forget.

Cpt, I've been following this thread with some interest. I'm on the Discovery Classic Priority plan, with a wife & two kids (4,5 & 7). Would you mind expanding on why you don't like the priority plan & gap cover, does this cover the difference between a specialist / physiuos fees and what the medical aid pay or this this to cover the payment gap in the medical until Discovery starts paying again ?

[Blindspot]

ricochet_rabbit, on 23 November 2012 - 01:32 , said:

Cpt, I've been following this thread with some interest. I'm on the Discovery Classic Priority plan, with a wife & two kids (4,5 & 7). Would you mind expanding on why you don't like the priority plan & gap cover, does this cover the difference between a specialist / physiuos fees and what the medical aid pay or this this to cover the payment gap in the medical until Discovery starts paying again ?

Eish, you have bigger problems

[cpt armpies mayhem]

ricochet_rabbit, on 23 November 2012 - 01:32 , said:

Cpt, I've been following this thread with some interest. I'm on the Discovery Classic Priority plan, with a wife & two kids (4,5 & 7). Would you mind expanding on why you don't like the priority plan & gap cover, does this cover the difference between a specialist / physiuos fees and what the medical aid pay or this this to cover the payment gap in the medical until Discovery starts paying again ?

It's a personal preference, dude. Unless you spend ALL the threshold, the Priority plan isn't worth it. It's the only plan with deductibles for certain procedures, it's also the plan that you can't move from in the middle of the year (ALL plans are seen as an upgrade from Priority as none of them have deductibles)

In terms of the monetary difference, it makes more sense (most times) to be on a Coastal / Classic / Essential Saver type plan and invest the difference. Same in-hospital & chronic benefits, just that it has a piddly above threshold benefit, for which you pay out your ass.

The Gap Cover will cover the diff between specialist rates & med aid coverage rates, in hospital only. Not the Self Payment Gap. And it won't pay for a physio, as that is seen as a day to day expense and comes out of your MSA / ATB.

I will have to run the figures for the 2013 levels again in order to get a definitive result, but I never recommend Priority for my clients. It just has too many idiosyncracies (deductibles & limited ATB) that make it unattractive.

[agteros]

I'm leaving Discovery Health (Classic Comprehensive) after about 14 years of membership at the end of this month. Joining Bankmed. Hope they give me as little hassles as Discovery!

[dracs]

Can anyone give a quick med aid tax for dummies synopsis?  My understading is there are big changes (re tax credit instead of deduction?)

Our company changed to a full cost to company basis during the last yr.  As a result there is no longer an automatic benfit in by choosing a more comprehensive plan (in the past the company matched my contribution).  At the same time the ability to claim med expenses not paid by med aid is alsmost zero (i worked out when doing my 2012 tax I would have had to have incurred over R60k med expenses not paid by Discovery to get any tax back).

So, I'm tempted to downgrade from classic comprehensive, but this is offset by the fact that I will incur more med expenses myself for which i won't get a tax benefit.  The bottom line then seems to me to be is there more of a tax benefit for an extra rand spent on med aid vs spending than rand directly on medical expenses?   Also a family of 4 with small kiuds by the way - so we tend to hit above threshold benefit by August each year...