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Medical scheme membership is considered by many to be more important today than ever. Why? Because medical inflation keeps rising, making medical care and medicine more expensive every day. Moreover, should you wish to receive the best possible care money can buy when you are at your most vulnerable, you would want to have a choice in who your doctor should be, or where you receive that treatment. The decision of which medical scheme to choose is, however, not that simple. Currently, 124 medical schemes are registered at the Council for Medical Schemes, of which 41 are open schemes. These cover a broad spectrum of benefi t options: from very basic hospital plan type options to a combination of hospital and day-to-day cover.

“Making the right choice as to which medical scheme and which benefit option will suit you or your family best depends a great deal on what it is that drives your decisions,” says Marthie Bester, Marketing Director of Selfmed Medical Scheme (Selfmed).

“People are motivated by different factors and it is therefore not always just a simple decision that boils down to the best value for money.

“When choosing a medical scheme you have to ask yourself the following: What is important to you and what would influence your decision to join a medical scheme? We have found that healthcare consumers that chose Selfmed mostly value a personalised approach, excellent service, the security of belonging to a well-established medical scheme with high reserve levels and benefit options that are simple, easy to understand and without any added frills,” she says.

However, as the choice of a medical scheme should be a highly personal one, she suggests answering the following questions to help you determine your choice of medical scheme:

1. Do you require simple, no-frills medical cover or would you prefer additional frills such as the free gym membership or other rewards that are offered through loyalty programmes as well?
While the additional frills are nice to have, they are defi nitely not free. As a healthcare consumer you will have to foot the bill for these add-ons in some way or another – usually through your monthly contributions that may be a bit higher than those of a no-frills medical scheme. Selfmed’s offering is typically the no-frills type, with clearly defi ned benefits that all are medical in nature.

2. When phoning a call centre, would you prefer to deal with a large administrator that deals with several members from different medical schemes or would you rather speak to an agent that has only the members of one scheme to service? Selfmed has a dedicated call centre where every service agent is trained to handle any request or query members may present them, without having to refer you to someone else. As a result Selfmed members have become used to impeccable service levels and personal attention.

3. Is the size of the medical scheme more important to you or its fi nancial stability? Are you happy with the reserve levels of the scheme you are considering? These questions are intimately linked since a medical scheme’s financial stability can be gauged by the strength of its reserve levels. While many of the very large medical schemes may seem a safe option
simply because of the belief that there is safety in numbers, these schemes do not necessarily meet the legal requirement which states that their reserve levels should be at 25%. Selfmed’s reserve levels have been well above the 25% mark for a few years now – a clear indication that the scheme is financially very sound.

4. Do you mind being told to which doctor or dentist to go to or would you prefer to use any doctor or medical service provider of your choice? Many medical schemes can keep their
monthly member contributions lower by subscribing to a specifi c doctors’ network or group that you may consult. If a member does not consult a doctor or medical professional that forms part of the prescribed network or group, the scheme simply does not pay the doctor’s bill, which would then have to be paid by the member. Selfmed places no such limitations on its members and they are free to consult whichever healthcare professional they are comfortable with.

5. Can you afford the right option on the medical scheme that you are considering or would you have to buy down when their premiums increase? Are other schemes offering similar benefits at a lower cost? As medical infl ation rises year on year, so too do member contributions – and sometimes even half-yearly. You may be able to afford the best and most expensive option a medical scheme has to offer now, but many people fi nd themselves in a position where they have to move to a lower option with less benefi ts than they are used to once those contributions rise. Don’t simply take the most extensive option if it offers far more that what you actually need. Selfmed will meet your specific requirements with an appropriate
benefit option that fi ts your needs as well as your pocket.

6. I s the scheme you are considering viewed as an ethical participant in the medical schemes environment and do they have a good track record and reputation? Is this important to you?
When a medical scheme subscribes to the ideals of business ethics, it means that it can be trusted, that it provides its employees with defi nite service and behavioural guidelines and, as a result, it will have responsive member service. It also means that it is an organisation that can be trusted with your money, which you are effectively giving to them to look after for you until you need it in a medical situation. Selfmed was established more than 40 years ago and has an impeccable track record within the South African medical schemes environment. Selfmed furthermore joined the Ethics Institute of South Africa, which means that it subscribes to every ideal of good, ethical business practice.
“These are only a few of the questions you should be asking yourself before choosing a medical scheme or changing from one scheme to another,” says Bester. “It should be about what you consider to be more important, more appropriate and more suited to your needs that counts. When it comes to simple, sincere medical cover, dedicated, personal service and financial security, Selfmed is the medical scheme that stands out from the rest.”

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