Good Questions to Ask Health Insurance Brokers in The New Year

It’s the start of the new year, which means it’s time to speak to your health insurance broker about your current medical insurance plan. Bloom strongly advises all prospective members and policyholders to schedule some time to discuss their chosen or current health insurance plan with a trained broker each year. This is due to the fact that your medical priorities or budget may change, which could call for some adjustments to your current plan. Likewise, there may be administrative or policy changes that you need to be made aware of so you can make an informed decision. Find out what good questions you should be asking health insurance brokers in the new year.

1. What is the difference between health insurance and medical aid?

For those who are still undecided about whether they should be choosing a medical aid scheme or health insurance, there is some clarity in providing an explanation about the differences between medical insurance vs medical aid. Health insurance is more cost-effective than medical aid but it does offer less in-hospital cover. Payments are made directly to the health insurance plan member who then settles with the healthcare provider. A medical aid scheme, in contrast, provides cover based on a medical scheme tariff. Members pay a fixed monthly fee and there is a standardised prescribed minimum benefits list. Payments are usually made directly to the healthcare provider.

2. What types of health insurance plans are available?

Bloom offer three types of affordable, comprehensive health insurance with Health4Me. These include:

  • Health4Me Bronze. This is the entry-level option and the most affordable health insurance plan available. The plan is tailored to cover day-to-day cover.
  • Health4Me Silver. This health insurance provides a more balanced plan that covers the essentials, with additional benefits to the member.
  • Health4Me Gold. This is the premium health insurance plan, which offers the most healthcare cover and benefits.

3. What is the cost of health insurance?

Bloom offers a range of affordable health insurance plans. In order to qualify for health insurance cover though, you need to be over the age of 18 years and earn a minimum of R8,000 per month and less than R30,000. The most current 2022 health insurance costs are as follows:

  • Health4Me Bronze. R570 per person per month.
  • Health4Me Silver. R610 per person per month.
  • Health4Me Gold. R658 per person per month.

4. What is covered by health insurance?

There are two main areas of health insurance benefits offered by the Momentum Health4Me cover. The first is day- to- day cover and the second is hospitalisation cover for major medical events. Day-to-day covers includes specialist benefits like a visit to the gynaecologist, GP visits and chronic conditions benefits. The major medical events benefit relates to in-hospital cover and medical events, such as requiring hospitalisation following a car accident or after having suffered a heart attack or stroke.

In addition, health insurance members can choose their cover from a list of benefits that suit their budget and medical needs. This is called the building block method, which means health insurance is more flexible in its approach than most medical aid schemes. It must be noted, however, that health insurance offers less in-hospital cover than a medical aid scheme. Health insurance in-hospital cover is limited to accident and emergency care only. Should a policyholder require a planned surgical procedure, such as a knee replacement relating to a pre-existing injury, they will need to provide the hospital with a guarantee of payment letter before being permitted admission.

5. What type of limitations are there with health insurance?

Limitations refer to the cap on the value of your benefits for a particular service or benefit. Limitations and restrictions will apply to all health insurance plans. The particulars will depend on the type of plan you choose, as well as your benefits limitation value. One must also consider out-of-pocket costs, which are costs that fall to the policyholder to cover. These costs are not covered by the health insurance plan. When a member has exceeded their benefit limitations, they will have to cover the difference out of pocket. It’s a good idea to discuss limitations per benefit with your broker so you can plan accordingly.

New claims form 2022 available for download

The Momentum Health4Me Claims Form 2022 is now available to download directly from the website. Check out our guide about how to submit a claim if you’re unsure how to do so. Your broker will also be in a position to assist, which makes this a good question to ask a health insurance broker this year.

Get affordable health insurance with Momentum Health4Me

Health insurance helps you prepare for the future, and good quality medical care can prove quite costly which is why you need affordable, comprehensive health insurance. Make sure you receive top-quality care at a private medical facility by getting medical insurance. Speak to a health insurance broker each year to reassess your plan. Contact us at our office for more information or for a free health insurance quote.

Medical Content Disclaimer

You understand and acknowledge that all users of the Bloom website are responsible for their own medical care, treatment, and oversight. All content provided on the website, is for informational purposes only and does not constitute medical advice. Neither is it intended to be a substitute for an independent professional medical opinion, judgement, diagnosis or treatment.

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Momentum Health4Me is not a medical scheme product, and is not a substitute for medical scheme membership. The information provided on this website does not constitute advice in terms of the Financial Advisory and Intermediary Services Act. Momentum is a division of Momentum Metropolitan Life Limited, an authorised financial services provider (FSP 6406) and a wholly owned subsidiary of Momentum Metropolitan Holdings Limited.

Bloom Gap Cover is not a medical Scheme. Products that are offered are not the same as that of a medical scheme.

© Bloom Financial Services 2023. Bloom Financial Services (Pty) Ltd is an authorised financial services provider (FSP 50140). Bloom Gap is underwritten by Infiniti Insurance Limited a licensed non-life insurer and an authorised financial services provider (FSP No.35914)

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