While you may have medical aid coverage, chances are that this coverage isn’t going to cover everything, and if it does, make sure that you keep a death grip on that plan. As unfortunate as it may be, there are simply things that just aren’t covered in your medical aids, and you’re going to have to find a way to finance these costs. From a legal standpoint, many of the medical aids don’t actually have to cover every medical cost or procedure, and they do have the right to draw a line where they will no longer cover certain procedures. There are many things that obviously can’t be claimed for your medical aid, there are things that you should be aware of, especially if you have a cheaper medical aid plan, as you may not be able to claim all of the expenses that you think you can.
One thing to think about when it comes to the benefits of your medical aid plan is the PMB, or the Prescribed Minimum Benefits. And this is the portion of your medical aid plan that is required to be paid for by the company you get your medical aid form, but within the PMB, there are also many aspects that the companies can decide to cover or not, based on their own preferences and discretion. If you’re unsure of what will be covered or not, think and use the example of the coverage you have with typical home insurance to be sure. When you have a wall in your home that collapses, the home insurance will foot the bill, but if you want to tear down the wall and rebuild it, then they don’t have to pay.
And within the medical aid plans, there is also what is considered “sub-limits” and this means that even if the company that you have for your medical aid plan, and they do agree to pay for a program like rehab or nutritional counseling, you can’t expect them to continue to pay for all of these programs and expenses forever. Depending on the medical aid plan that you have, there may be different rules that can apply to your coverage, so make sure that you read all of the fine print on the contract that you’ve signed for your medical aid. While you may not want to take the time to read all of the details of your plan, it is necessary so you can see exactly what will be covered before you go out and have a procedure done.
Expect there to be a refusal from your medical aid plan to pay for:
- Any professional contest injuries where you need medical assistance
- Any medical or surgical procedures that are due to an obesity condition
- Any infertility treatment or contraceptive device costs
- Any treatments or operations that are done for cosmetic reasons
- Any experimental surgeries or procedures
- Costs for donating any organs or tissues
- Any consulting fees that are done after hours that are a non-emergency