Should you join a loyalty programme?

If your medical scheme offers a loyalty or rewards programme, you must establish whether it will work in your favour before joining it, Philip Ferreira says.

If you do not use the programme and benefit from it, you will be subsidising the rewards enjoyed by the other members of the programme, he says.

Medical schemes cannot discount your contributions if you lead a healthy lifestyle, but many rewards programmes incentivise their members to eat healthy foods, exercise and go for check-ups. This can be to the scheme’s advantage, because the healthier its members, the less it will have to pay out in claims for medical treatment.

Ferreira says you do not have to join a loyalty programme when you join a scheme; you can do so later once you have determined that it will be of value to you.

Preferred providers You should find out if your scheme has preferred providers for healthcare services not covered by the PMBs, Ferreira says. Preferred providers have entered into payment arrangements with schemes, and if you use these providers, it is more likely that your scheme will pay your claims in full, or, if the claim is paid from your savings account, it may be cheaper, and your benefits will stretch further.

Benefits often have limits Understand your benefit limits, so that you will know where you may face a shortfall in your cover, Ferreira says.

For example, your medical scheme may have an annual limit of R200 000 on specialised medicines, and you will have to pay out of your own pocket if your treatment costs more than this amount. of 35 or if there is a gap of more than three months in your membership when you switch medical schemes after the age of 35.

The penalties range from five percent to 75 percent of your contributions, depending on the break in your membership after the age of 35. Schemes tend to apply these penalties for as long as you remain a member.

Waiting periods/late-joiner penalties aren’t mandatory; schemes may waive them.

Another right of which you should be aware is that you can change options within your medical scheme once a year at the end of the year, Ferreira says. Most schemes allow you to downgrade your option at any time, but few allow you to upgrade during the year, he says.