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Monday 22 April 2019
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Are you medically insured?

No one plans to get sick or hurt, but the worst thing is not getting the right medical attention at the right time because of not being able to foot the bill. Countless people have been complaining  about the long queues in public hospitals and the lack of proper medical care.

Others have been denied emergency attention because they are unable to pay the entry bill. It is frustrating, but as such, you will need medical insurance at some point in your life.

Young Thomas Mwadikange was unable to be admitted in a private hospital because he did not have medical aid and as a result was turned away. “I went to a Windhoek hospital to seek medical attention but they said they will not attend to me if I could not prove how I was going to settle the bill. I was just a graduate and needed urgent attention. The state hospitals were full and we all know the hustle of our government hospitals,” he said.

The story of Thomas is nothing new to the life of many and one can imagine the frustration. So why then is it important to be health insured?

Namibia Medical Care (NMC) manager in the Premium division, Nick Nell says that medical aid is perceived to be expensive but it helps you in situations beyond any planning. In short, health insurance protects you from unexpected high medical costs.

“Imagine ending up in a hospital and they expect you to pay an upfront amount before treating you. No body plans when they will get sick such that they are allowed to save some money. So with medical aid, you are covered every time and you need not to be frustrated. Health insurance covers these costs and offers many other important benefits,” said Nick.

Having health insurance is important for several reasons. Uninsured people receive less medical care and less timely care, they have worse health outcomes, and lack of insurance is a fiscal burden for them and their families.

Health insurance covers essential health benefits critical to maintaining your health and treating illness and accidents. The eventuality of footing a high bill when going for a big operation is very high when one does not have medical aid.

“Imagine having to go for cancer treatment and you do not have medical aid. It will be almost impossible to pay that bill because the treatment itself, let alone the medication is costly.”

The Benefits

Hospital bills for very small to considerably large ailments are a pain. It is difficult to meet such costs on our own without burning a hole in your savings. Also, with medical costs escalating, some even compromise on quality healthcare, because of affordability. It is then that the importance of health insurance comes into the picture. It provides us with the ability to afford better healthcare facilities for ourselves and our loved ones.

Although sometimes expensive and unaffordable for low earning people, you pay less for covered in-network health care, even before you meet your deductible. Depending on the options that you choose on a particular medical aid scheme, you get free preventive care, like vaccines, screenings, and some check-ups, even before you meet your deductible.

While a single prescription or occasional trip to the doctor’s may fit into your budget, the cost of managing an illness or treating an injury can be financially devastating. Even the costs of routine care can add up over time. The good news is that having the right health insurance coverage can save you the high costs of a serious injury, hospital stay, or chronic illness as said by Nell.

“We live in an era where people get sick on almost a monthly basis. It is expensive, but you need it. What is more important is the peace of mind one has knowing that they need not to worry about being stranded,” said Thomas.

Like at NMC and other medical aid schemes, they have a network of hospitals where they have a direct billing arrangement. In such cases, the medical aid directly pays the admissible claim amount to the hospital. When the insured person is admitted in a hospital, their family would need to just submit their medical aid card and the administrators will process the transaction. The insured person will have to pay only expenses which are not covered under their option, which is in most cases a minimal amount.

Thomas, who now has medical aid says that one needs to understand that there is no perfect plan. As such, before knocking on the doors of any medical aid scheme, “you need to understand your needs well, plan for the long term, and go for the closest suitable plan. Do not wait for that perfect plan with everything covered to arrive and risk delaying your coverage because then it will also be expensive.”

Some NMC options

Nell emphasizes that the open secret about medical aid is that it is more expensive to apply as an individual that belonging to a group.

Topaz, Topaz Plus

This is the entry option and the cheapest in the medical aid scheme. It will cost and individual a monthly premium of N$487 and N$388 when one is in a group for the Topaz option. With Topaz Plus, individuals will have to fork out N$883 as an individual applicant and N$730 when in a group. What clients should know about this option is that there is a limited amount on day-to-day use.

Ruby

Many group applicants use this option as the benefits are more than that of the entry option. With Ruby, individual applicants will fork out a monthly premium of N$2557 while group applicants will only pay N$2096 between the age group of 36 and 40.

According to Nell, it is also worth to note that the medical aid premiums contributions are also influenced by the applicant’s age. The older you get, the more you pay. However, with the Ruby option, you have more benefits including a higher limit.

Other options are such as the Opal, Sapphire, Diamond, Emerald and the exclusive Amber option.

Irrespective of one’s age, health status or social standing, we are all at risk of landing in a hospital one day. While it is unfortunate that medical aid schemes are becoming expensive every year, it safer to have it when you need it than not to have it.




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