Most of us focus on the extremely high cost of medical care within hospital. While these medical bills can be exorbitant, especially if you need major surgery, another very costly aspect of medical care is for the treatment and management of chronic diseases. When looking at a medical aid, and a hospital plan specifically, remember that the chronic benefit is just as important as the hospital cover. Fortunately there have been some new regulations passed in recent years that does in fact protect South African consumers with regards to their chronic care.
Chronic Disease Management and Medication
Before understanding how chronic diseases are treated and managed, it is important to first understand what a chronic disease is and how it may affect your health. A chronic disease is any condition that exist for a long period of time. Not all chronic diseases are permanent. Some may only last for 3 to 6 months and can resolve on its own or be cured completely. However, most of the chronic conditions seen today are permanent. This means ongoing medical bills in order to treat and manage your chronic condition.
Although medication may not cure a chronic disease, drugs may still be necessary to manage the condition. This means that the medication keeps the chronic disease in check, reduces the risk of complications and in some instances even reverses the condition in the long term. However, chronic care on your medical aid is not only about medication. The chronic disease may also need to be monitored on a regular basis and the chronic cover on your medical aid may also cover diagnostic investigations, and even certain doctor’s consultations, that play a part in management.
Hospital Plan Only with Chronic Cover
These days a medical aid hospital plan is becoming the preferred option as the cost of full cover is unaffordable. With hospital costs being the most expensive, you should have a hospital plan at the very least if you want to access private health services in South Africa. Fortunately, almost all South African medical aids offering hospital plans also include chronic cover. This means that you can rest assured of private care for your chronic disease although you are out of hospital and in-hospital cover when you need it.
The benefit of a hospital plan with chronic cover is that you can keep costs down in terms of monthly premiums. You will then have to manage your day-to-day medical bills either by paying cash or going to a government clinic. But when it comes the the more expensive medical bills often requiring specialist medical care, you have cover for when you are in hospital plus your chronic benefit will ensure that you have the necessary services and drugs available on a monthly basis.
Benefits and Limits
The chronic benefit of a medical aid covers your chronic care needs. This includes drugs, investigative tests and sometimes even specialist consultations. However, there is an annual limit to this benefit. It is usually a family limit that includes all the members on the medical aid. Once it is exhausted you will have to pay for your chronic care out of your own pocket, or your day-to-day benefit should it still have funds.
Prescribed Minimum Conditions
Amendments to medical aid regulations in recent years has ensured that members are protected against exhausted chronic benefits. Since chronic conditions can be life threatening if not constantly managed, the prescribed minimum benefits (PMBs) ensures that you will be covered for 26 serious chronic conditions throughout the year. This means that even if your chronic benefit is exhausted, your medical aid will be compelled to pay for chronic care for these diseases.