Understanding Children’s Medical Aid/Insurance

If the COVID-19 pandemic highlighted something concrete, it was the need for a solid medical aid. Contrary to the view of most people, a medical aid/insurance policy is a must for your financial planning; we would think much more important ahead of funeral cover!. We have previously written on how to choose the best medical insurance/aid in general (see post here). But, as a parent/guardian, you will make a number of choices about your child’s health throughout their lifetime, including what medical aid/insurance to obtain. Medical Insurance/Aid is purchased to help cover the health care needs of your child/ren. Medical insurance for a child may be obtained through a parent’s employer, purchased through the insurance company directly, or provided through the government. However, not all medical aid plans are the same and naturally, some are better than others. When you select your child’s insurance plan, you may be looking for the lowest cost, but you should also consider which doctors and hospitals are covered by that plan.

As an absolute minimum, opt for an insurance that covers your child’s general practitioner and/or paediatrician. Your general practitioner acts as your gatekeeper and director to other specialist services your child may require. For children who might require specialist care, or are on long term therapy, a more comprehensive insurance maybe required to reduce the amount of out-of-pocket payments or shortfalls along the way.

Here are some important points to think about as you make a choice for your child’s medical aid.

  • Adequate sum insured

  • Comprehensive coverage including for admissions, surgery etc at adequately equipped medical facilities

  • Understand the limits and sub-limits . For example, some plans are limited to certain hospital grades, or to general wards excluding private wards.

  • Hospital network of the insurance company. Make sure you know if your insurance plan is tied to a particular hospital network. Out-of-network services may require cash upfront.

  • Pre-existing waiting period. Make sure you know the association rules on this before signing up your child.

  • Compare the premiums. Health insurance is offered by multiple insurance companies. Every company has its own pricing policies, and track record. Do not overlook these.

  • Consider the exclusion list. For example, some insurance companies will not cover for birth defects. Some parents have found out a little too late!

Choose a health insurance policy after you have considered all the above-mentioned views. This would help you find the most relevant and the best health insurance plan for your family.

(For other topics on children’s surgery, head on to our Facebook page and discover more!)

Leave a Reply

Your email address will not be published. Required fields are marked *