Our lives change constantly year to year and with change comes medical change.

Choosing a scheme that’s good for you and your family. When deciding on a medical scheme there are three key points you need to consider:

Keep your options open at all times: Select a medical scheme that offers a range of options that will allow you to move between plans as your lifestyle needs change. Once you have children you may want a higher level of day-to-day and specialist cover. As you get older you may want an option that provides extensive chronic cover.

Brand does make a difference: Over the last few years several medical schemes have gone under. In this tough economic environment only strong schemes will survive so it is better to opt for large schemes with well-known brands that cannot afford to go under.

Risk or savings: Ask, ask, ask. Some medical schemes pay for emergency trauma expenses from risk cover, which does not deplete your savings. But the more expenses are paid for from savings, the faster this will be depleted.

How to choose your scheme Once you have selected a medical scheme, or have one chosen for you by your company, selecting the right plan for your needs is just as important so here are a few tips.

How much cover do you need? Analyse your medical expenses over the past year and compare that to your claims record to see if you are under-or over-insured. At the end of every year you are able to change the level of your cover, so rather go for extensive chronic cover only when you need it.

Subsidy policy: Although from a tax perspective there is little benefit in being on a more expensive scheme, some companies do have a subsidy policy. If your company is subsidising your premiums, then it may be worth taking out comprehensive cover.

Cover the emergencies: Good hospital cover is critical. Medical cover should be treated as insurance for unexpected events rather than a savings fund. Most medical schemes offer hospital cover of 200% to 300% of the National Health Reference Price List (NHRPL). The NHRPL is a list of medical fees recommended by government, but most medical costs exceed these. Some medical schemes such as Discovery Health have agreements in place with certain specialists that they will pay the fees in full. They have similar agreements with hospitals. But if you use a doctor outside this network you may find that you need to pay in. Other schemes such as Fedhealth will pay the full fees for an emergency but will only pay 200% of NHRPL for elective procedures.

Health audit: Do a health audit on your family to assess the medical costs you are likely to incur and select the correct level of cover. Theoretically, if you are going to have an operation you could change to a plan that does not require a co-payment. But these options tend to be significantly more expensive, so do your homework. It may be cheaper just to pay the co-payment than fund the difference in premiums for a year.

Why it is important to review your options

Just looking at my medical scheme’s price and product list for next year indicates how important it is to review medical cover each year.

Its not always ideal to change medical scheme year on year. Over time you will reap the benefits of a well-managed scheme and a large increase in one year may be followed by a lower premium increase the following year.

If the scheme is well out of line with prices from other schemes, it may be worth making the change because the profile of the membership may result in continually high premium increases or drastic cover reduction.

Be aware that some schemes may announce lower premium increases but could be cutting some of the benefits, so you need to understand the underlying benefits. Also don’t just accept the covering letter stating the average premium increase.