total risk administrators (TRA) logo

Tips To Stretch Your Medical Aid Benefits

medical form

Private healthcare can quickly delve into your hard-earned cash if you do not keep close tabs on the limitations of your medical aid benefits and your co-payment expenditure. It is important to manage your medical expenses smartly if you want these benefits to last. Here are a few tips to save money to make the most of these benefits while managing your health.

How to make your medical aid last longer

  1. Gap Cover
    If you have any concerns about potential co-payments, gap cover could help avoid costly out-of-pocket in-hospital medical fees. Gap health insurance works with your medical plan to close in-hospital payment gaps if your medical aid benefits are exhausted.
  2. Look for generic medicines
    Generic alternatives to original brands are often priced at a fraction of the cost, and medical schemes will typically pay in full for generic options. If the generic medicine has the same active ingredient as the original brand, it will be just as effective with the same strength and dosage. You can ask your pharmacist for generic options, especially if you are on chronic medication.
  3. Don’t ignore Managed Care benefits
    Carefully study your medical aid plan to see whether your scheme offers any Managed Care programmes. These programmes typically help those who need to manage chronic conditions such as diabetes, cancer, and HIV/AIDS. The programmes are usually funded by your medical contribution’s risk portion and not from your savings account – meaning that you are getting the most from your benefits while receiving the medical care that you need.
  4. Look for Designated Service Providers (DSPs)
    Try to find DSPs when you are looking for a hospital, doctor, or pharmacist. These providers have partnered with medical schemes and won’t charge more than a negotiated preferential rate. Using DSPs means that you can avoid or lower potential co-payments.
  5. Ask questions
    If you need to be hospitalised for a routine procedure, ensure that the hospital and doctors are on your medical scheme DSP list. Take time to ask your doctor or specialist how much they will charge and ask them to explain the bill in terms of your medical aid coverage. Should your medical aid not cover enough of the doctor’s fee, ask your doctor whether they would be willing to negotiate a lower rate. Ensure that you have obtained the necessary pre-authorisation for procedures and that the correct ICD-10 codes are being used.

If you would like more information on our Gap cover plans to boost your medical aid benefits, contact the Total Risk Administrators team today

Note: All material on this website is provided for your information only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on and matter relating to their health and well-being. The information and opinions expressed here are believed to be accurate, based on the best judgement available to the authors, and readers who fail to consult with appropriate health authorities assume the risk of any injuries. Errors and Omissions Excepted. Terms and Conditions Apply.


12 July 2024News, TRA News

Unpacking Gap Cover Service Providers: TRA and Stratum Benefits Gap Cover 

Gap service providers are crucial in bridging the financial shortfalls that medical aid may not fully cover. This article will

12 July 2024News, TRA News

Unpacking Gap Cover Service Providers: TRA and Dischem Gap Cover

Signing up with a gap service provider ensures the financial shortfalls that your medical aid may not fully cover are

Read More
25 June 2024News, TRA News

Unpacking Gap Cover Service Providers: Discovery Gap Cover

TRA and Discovery Health Gap service providers are essential in covering the financial shortfalls of the medical scheme (medical aid),

Read More