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October and November is the time of a year to review your healthcare cover once you receive communication from your Medical Scheme regarding their annual contribution increases and benefit updates for the next year. Medical Schemes allow members during this time of the year to review your healthcare needs, change to another option or you might even decide to move to another Medical Scheme. This important decisions must be done before the cut-off dates allowed by your scheme, usually by the latest the first week in December.

Choosing the most suitable medical scheme option for you and your family can be difficult and it’s important to consider the following:

  • Compare the contributions and benefits of your current and future options and decide whether the increased cost and benefit changes still suit you and your family’s healthcare needs. Calculate your medical expenses for the current year to determine if a more expensive option will be cost-effective.
  • If you decide to move to another medical scheme, familiarize yourself with the financial position and average age of the scheme. This will give you an idea of the ability of the scheme to pay claims and the age represents the risk and claim pattern of the scheme.
  • Take note of conditions and benefits not covered for example exclusions, co-payments and anticipated procedures before you make a decision.
  • Although the Medical Schemes cover certain prescribed minimum benefits by law, ensure that the scheme receives the registration documents and send you confirmation once approved. You might be restricted to certain processes and providers to be covered in full.
  • Medication formularies and treatment plans may vary on higher and lower options.
  • Decide if option restrictions for example doctors, specialists and hospitals on the provider network will be acceptable and suit your needs.
  • The addition of dependants may have a significant influence on your decision and therefore confirm with the scheme how they calculate premiums for children, full-time students and adult dependants.

It is in your best interest to take time to review your healthcare cover for the next year as a medical scheme constitutes a legal contract and therefore important to understand the terms of that contract.

Please contact Simeka Health on 0860 122 340 or complete the on-line needs analysis on and we will contact you to assist you with the right choice best suited for you and your family for next year.



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