You may be young and healthy now but there is no guarantee that you will not need medical care very soon. In fact it is definite as you get older. One of the major reasons for medical aid claims relates to chronic conditions and this means ongoing medical treatment which can be costly. While government facilities in South Africa does offer chronic care, many South Africans prefer private health services. But this means having the financial resources to pay for it. If a full medical aid is not an option for you then you can opt for hospital cover which includes chronic benefits.
Common Chronic Diseases
So what is a chronic disease and how will it impact on your budget? A chronic disease is any condition that persists for long periods of time. It is either continuous or tends to recur frequently. Typically these conditions will last for more than 6 months and often it will be present for a lifetime. Common chronic diseases include:
- Hypertension (high blood pressure)
- Diabetes mellitus (sugar diabetes)
- Hypercholesterolaemia (high blood cholesterol)
- Joint diseases like osteoarthritis and rheumatoid arthritis
- Skin diseases like psoriasis
- Autoimmune conditions like inflammatory bowel disease (IBD)
Certain cancers and even HIV infection fall under the chronic condition category in that it requires long term management. Chronic care means that you will need medication over a long period of time along with regular tests to monitor your condition. Hospitalisation may be necessary on on occasion, especially if the condition is poorly managed, with surgery in some cases.
Types of Medical Cover With Chronic Benefits
Firstly it is important to realise that only medical aid will pay for chronic care. Hospital cash back plans (also known as hospital insurance) only pays for the days you spend in hospital, irrespective of whether it is for acute or chronic care. Even medical aid hospital plans will include chronic benefits in addition to hospital cover so you do not need a full medical aid plan. But remember that there are waiting periods applicable to chronic conditions that were present before you signed up for medical aid. In terms of the pre-existing condition clause, you will have to wait 12 months before medical aid starts paying for chronic care in these instances.
But chronic conditions can be expensive to manage. There is an annual limit that applies and if this chronic limit is exhausted, your medical aid will not pay for any more chronic medication until the new year starts. However, this break in medical care can be devastating in terms of management of the chronic condition. Sometimes it can even be life threatening. Recent change in regulations has tipped the scales in the favour of the medical aid member. Now patients with potentially life threatening chronic conditions are guaranteed year long cover by the medical aid. This is known as prescribed minimum benefits.
Unlimited Chronic Cover
Most medical aids have an annual overall limit for chronic conditions. But with 25 medical conditions the cover is unlimited. These conditions that fall under the prescribed minimum benefits (PMBs) includes conditions more common conditions like hypertension and diabetes to less common illnesses like certain cancers. This means that a medical aid member with a PMB will receive medication and other related services for the treatment and management of their condition throughout the year. There is no interruption in chronic care. HIV infection has also been included under PMBs thereby ensuring that patients have cover for their ARVs throughout the year.
Considering the exorbitant cost of hospital care and then the expenses associated with ongoing management of chronic conditions, hospital cover should be considered as essential unless you are prepared to use public health services. A chronic condition could add thousands of rands to your monthly budget if you do not want to go to a government clinic or hospital and do not have medical aid. As you get older the onset of a chronic disease is almost guaranteed. For this reason hospital plans for pensioners is necessary if they cannot afford full medical cover. Hospital cash back plans do not cover people older than 60 to 65 years of age and either way do not offer this level of chronic cover as medical aids.