CAMAF Member Option Guides & Info

4 decide whether you are disciplined enough to carry your day-to-day medical and dental expenses. also determine how often you anticipate visiting your doctor for minor ailments, e.g. colds and flu. If you are able to set aside money on a monthly basis for day-to-day costs and/or do not visit the doctor regularly for ad hoc illnesses, a hospital plan may be ideal for you. these options are generally cheaper and they cover all the essentials should you be hospitalised. In any event most day-to-day benefits have a limit, which is usually exhausted before the year-end. if you have been diagnosed with a chronic condition or have family history placing you at risk for certain diseases, choose an option with adequate cover for the condition. look for income-based options if you are price sensitive. options with a network of providers are often cheaper; but may offer limited benefits. If you cannot afford to pay for a doctor's visit and claim back from your medical scheme, the network options are often a good choice as there are usually few instances of co-payments. However, there may be limits on basic services such as x-rays (Radiology), blood tests (Pathology) and dentistry. 1.4 Why cAn I noT choose The MedIcAl scheMe To WhIch I WIsh To Belong? Many schemes do not make provision for an employer to allow their employees to select from more than one scheme. as mentioned in 1.1, each scheme has a fund pool that must cover the costs of the health requirements of all the members over an extended period of time. the membership of all schemes is made up of healthy and unhealthy, young and older members and, claimers and non-claimers. as in any mutual type structure, the non-claimers pay for the claimers; except in the case of day-to-day benefits. if employees were allowed to select whether they want to join their company's scheme or not, many would not join until they are faced with major expenses. the problem then is that they will have had no time to build up their share of the reserves, which the scheme draws on when major claims arise. a scheme that only has claimers who have not built up some reserves will very quickly be bankrupt. All schemes therefore require the full risk pool of an employer. It is very rare that a closed scheme will allow an employer to offer an alternative scheme. Ultimately it is the executive team of the employer that must identify the scheme which best meets the needs of their employees. an inadequate scheme will generally fail to meet the needs of their employees and, will put the employees' health at risk. This will, inevitably, result in an increased level of absenteeism.

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