The new book aims to bridge the gap between medical schemes and their members.

Medical schemes are notoriously difficult to understand, as many hapless scheme member has discovered when they submit a claim only to have it rejected.  Now, a new book, “Medical Schemes Explained: Your Ultimate Guide to Using Your Medical Scheme Efficiently”, promises to break down the walls that create misunderstanding and confusion, in a way that will benefit both members and the industry at large.

Written by financial services expert, Andre Jacobs, the book has received rave reviews from principal officers and CEOs of various medical schemes and a previous Registrar of the Council for Medical Schemes for its ability to explain the complexities of medical schemes, in language that is easy for the layperson to understand.

Andre Jacobs

Jacobs, who has more than 35 years of extensive experience in the financial services industry with a special focus on healthcare, brings a deep-rooted interest in consumer activism to his book.

“In South Africa, the high cost of private medical scheme cover means that only 48% of the employed population belongs to a medical scheme – and even this group finds it to be too expensive,” he says.  “The average family pays R6000 or more a month for their medical scheme benefits, and many of them are in fact paying too much, simply because they do not understand the way their scheme works.

“This book aims not only to show them where and how they can save money but also how to avoid finding that they are out of pocket because they are not as covered as they thought they were.”

The high cost of misunderstanding

According to Jacobs, research shows that when it comes to appealing decisions of medical schemes, only 45% of people receive decisions in their favour.  “In fact, failing to understand their scheme can cost members more than R20 000 a year,” he says. 

The book contains 25 chapters that explain everything from the rights and obligations of both medical schemes and their members, the types of benefit options and how to know which one is best for you, to the many terms that are often misunderstood, such as “waiting periods”, “hospital reimbursement rates” and “unlimited” in-hospital cover, to “co-payments”, “deductibles” and many more.  Multiple examples further help to explain the content.

It also contains a chapter entitled “50 Tips to manage your medical scheme effectively”, which lists invaluable advice when selecting your scheme and benefit option, how to avoid the common major pitfalls, and how to use your benefits wisely and effectively.

By applying the 50 lessons learned in the book, Jacobs believes members can reduce their health expenses by a minimum of 10% per annum.

High praise for the book

Former Registrar for the Council for Medical Schemes, Danie Kolver, believes the complexity of the medical schemes industry has long been a source of discontent among members, making the book a timely work that will go a long way to improving the relationship between schemes and their members.

“This book will play a vital role in overcoming the asymmetry of information that exists between medical scheme members and the schemes themselves, which places members at a considerable disadvantage,” he says.  “Coming as it does now, with research showing that consumer satisfaction with medical schemes is at a six-year low, this book closes that gap. 

“I highly recommend it to every medical scheme stakeholder – policy-makers, intermediaries, administrators, employers, and, especially, to medical scheme members, whose healthcare needs change over time, and who need to be guided and advised accordingly to ensure they are appropriately covered.”

About Andre Jacobs

Andre Jacobs has written more than 200 articles on financial services, appeared on radio and television, and has represented the financial services industry in Parliament.  Over the last 35 years, he gained extensive experience in the Financial Services Industry and in healthcare, a sub-field of financial planning.

Key highlights of his career include:
*             Co-author of a range of financial planning course materials and books.
*             Represented Business Unity South Africa at NEDLAC regarding NHI
*             Published a research paper for BUSA titled the Economic Impact of Ill Health”
*             Represented intermediaries in Parliament regarding the FAIS & Medical Schemes Acts and &

              NHI proposals.
*             Prepared the intermediary response to the Health Market Inquiry.
*             Serves on the Council for Medical Schemes committee to find solutions for low-cost medical


*             Serves on the Exco of the Healthcare practice of the FIA
*             Fulfilled senior roles at large corporate brokerages and trained most of the staff of the large

*             Assisted medical schemes in improving their governance & enhancing their distribution


Biggest lifetime achievements
1.            X suffered from arthritis & her medical scheme did not want to pay for the expensive

medication. I won her case & she could get the medication. She was wheelchair-bound after taking the medication walked into my office.
2.            B received a preauthorization for a triple heart bypass. The medical scheme refused to pay his claim because they wrongly imposed a waiting period. I won his case & the medical scheme had to pay R 477 000.
3.            P was a pensioner & the medical scheme refused to accept her. Her case was won the case, but

the scheme kept on appealing. I won all the appeals. (see Jacobs vs Discovery)
4.            Pioneered MedCare, the first alternative dispute resolution service for medical scheme

members serving more than 45 000 families




About MiggieK

I am passionate about people, visual & performing arts, and my Mannatech business. I believe in God and love my family and friends!

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