Mind the self-payment gap on higher medical scheme options
20.05.12
As a medical scheme member, you may be on or have been advised to join an option that has a safety net of day-to-day benefits paid for by the scheme that kick in once you have exhausted your medical savings account.
The idea behind above-threshold benefits is that you have a financial cushion if your annual day-to-day medical expenses exceed the annual amount in your savings account.
Your day-to-day benefits are typically for out-of-hospital health care, such as visits to doctors, medication, optometry, dentistry, and some pathology and radiology services.
You may be aware that there is a self-payment gap before the above-threshold benefits kick in. In other words, you must pay claims out of your own pocket once your medical savings account is depleted but before you qualify for the above-threshold benefits.
You can calculate the self-payment gap by subtracting the annual amount in your savings account from the threshold at which the above-threshold benefits apply.
Source: Independent Online