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What Exactly Are Co-Payments?

Co-payments, in simple terms, are like splitting the tab at a restaurant with your pals—everyone chips in for their share. But in the world of medical aid, it’s about sharing the cost of healthcare services. Now, co-payments can catch folks off guard if they’re not clued in. Imagine booking a table for two and finding out your friend’s bailed—you’re stuck with the bill. That’s how some feel when faced with unexpected co-payments for medical procedures or services. What are Co-Payments?…

Co-payments, in simple terms, are like splitting the tab at a restaurant with your pals—everyone chips in for their share. But in the world of medical aid, it’s about sharing the cost of healthcare services.

Now, co-payments can catch folks off guard if they’re not clued in. Imagine booking a table for two and finding out your friend’s bailed—you’re stuck with the bill. That’s how some feel when faced with unexpected co-payments for medical procedures or services.

What are Co-Payments?

So, what’s the deal with co-payments? Well, they’re a set amount your medical aid scheme expects you to cough up from your own wallet. It’s like bridging the gap between what your medical aid covers and what your doc or hospital charges. And the size of your co-payment depends on a few factors:

  • What type of healthcare service you’re getting covered
  • Where you’re getting it done
  • How much the service provider charges (especially if it’s more than what your provider covers)

For Example: 

Discovery’s Classic Smart Plan

 Procedure/Service Co-payment Required
GP Visits Can go as many times are you like to a GP in the network   R65.00
Optometrist An eye test at a network optometrist   R65.00
Dentistry 1 check-up per a year at any dentist, dental therapist or oral hygienist R120.00
Sport-related injuriesR120.00 for x-rays

Discovery’s Essential Smart Plan

Procedure/ServiceCo-payment Required
GP Visits Can go as many times are you like to a GP in the networkR120.00
Optometrist An eye test at a network optometrist  R120
Dentistry 1 check-up per a year at any dentist, dental therapist or oral hygienistR180.00

How to Be Aware of Co-Payments

Now, staying on top of co-payments isn’t exactly a walk in the park. Reading through your policy can feel like tackling a labyrinth of confusing terms and jargon. That’s where your insurance broker swoops in as the hero of the day.

We highly recommend getting cosy with your medical aid policy. But if the thought of deciphering it gives you a headache, fear not! Your trusty insurance broker should’ve guided you through your medical aid plan when you signed up. They’re like the translators of insurance lingo, ready to answer any questions or clear up any confusion you might have. So, don’t hesitate to give them a shout!

Clarity Employee Benefits is an authorized Financial Services Provider – FSP No. 51007. We specialize in medical, please do not hesitate to contact us if you are in need of health insurance guidance or advice or if you would like us to inform you of any co-payments required in your policy.

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