When do unlimited benefits have limits?

Often medical aid cover is sold on the preface of the unlimited benefits provided for high cost hospital-related procedures. It is commonly known that medical inflation outweighs CPI inflation every year and the costs of an unforeseen medical emergency in hospital can easily run into thousands of rands. As such, having unlimited benefits for hospital care offers real peace of mind and security against the costs of the unforeseen.

“Unlimited” medical cover

Medical schemes by and large do not publish the full set of their options’ scheme rules, unless specifically requested. Instead, a summarised version of the rules is published or sent to members and interested parties. The summarised version does not provide the same level of detail as the full set of Rules and can easily be misconstrued if not interpreted in consultation with a healthcare consultant.

Medical schemes often provide unlimited hospital cover (i.e. without an overall annual limit), but impose co-payments on specific elective procedures rendered in hospital. In addition, specialists treating a patient in hospital may be charging well in excess of the medical scheme rate, thereby creating an additional co-payment for the patient’s account. These additional co-payments may not always be clearly stipulated in the option information available to the public.

Selfmed Medical Scheme prides itself on being transparent in terms of the benefits offered by its various options. We offer members simplistic and comprehensive product information that adhere to our undertaking and value statement emphasising simplicity, sincerity, security and service.