Medical Aid Schemes: What Information is Used to Approve or Deny My Coverage?
Medical aid schemes must look at a number of different factors when deciding whether or not to extend coverage to you. The point of medical aid is to protect you if you encounter health-related hardships. They are also intended to help with more basic services, such as preventative care. The company understands that it takes on each policy holder with a certain amount of risk. This is why your medical history and personal information is reviewed before you are approved for coverage. The company must determine how much you are likely to cost them and whether it is a safe risk for them to take. When you apply for medical aid schemes, it can help to understand what information is needed to determine your eligibility.
Lifestyle and Habit Health Risks
The behaviors and habits you practice are a part of your lifestyle. Medical aid schemes do not ask about every aspect of your life, but they will want to know a little more about your personal habits, namely those that impact health. Smoking is a very common example. South African’s can choose to smoke or not smoke, which can directly influence the risk of cancer and other health complications. Many medical aid schemes ask potential policy holders if they smoke. This could cause the individual to be denied coverage however in most cases it will mean a higher monthly rate. Individuals who do not smoke tend to receive lower rates than those who do. If you smoke, this may be a good time to save yourself money and improve your health by quitting.
Medical and Family History
Medical aid schemes will also want to know more about your medical history. This is your personal health record and can show any indications of a disease or condition. It also helps the company determine if there are illnesses you may not have mentioned. If you are generally healthy and have no serious illnesses, then you will most likely receive a lower rate from medical aid companies.
Family history is another item sometimes used to determine whether you are eligible for coverage and how much you will have to pay. Some families have hereditary illnesses that may put you and your children at a higher risk for developing certain conditions, disorders or diseases. No one can control their family medical history. This is one area you cannot change when applying for a medical aid plan.
Income and Employment Status
When you submit quotes for medical aid schemes, they will most likely request your income level and/or employment status. In some cases, the company may specifically ask for your family’s gross income. This information lets the company know how much you can afford to pay each month. If you are unable to afford the medical aid policy, then there would be little point in offering coverage that will eventually terminate due to non-payment. Make sure you know how much you can afford to pay before applying. This will help you find medical aid schemes that work the best for your budget and increase your chances for acceptance.
