Your Employees Have Medical Aid. But Do They Actually Understand It?

The medical aid contribution.

It is a significant amount coming off an employee’s income – before the money even reaches their bank account. Every month, whether they visit the doctor or not. And that makes it easy to see it merely as a cost.

But there is a better way to look at it: as a valuable benefit.

Only about 15% of South Africans are members of a medical scheme. For most, private healthcare is simply out of reach.

So, when a company or employer provides medical aid, it gives employees access to something most South Africans do not have.

Providing the Benefit Is Not the Same as Employees Understanding the Benefit

As an employer, ask yourself this: “How many of my employees could explain what their medical aid covers?”

Not the name of the plan. Not what comes off their monthly pay.

But what the benefits cover. What the limits and exemptions are. Which doctors and hospitals are they allowed to use. What happens when their medical savings account runs out. What a co-payment means. What happens if they need a specialist or when they are admitted to hospital. What happens if they choose the wrong network of service providers.

And perhaps the biggest question of all: Do they know whether the option they are on still makes sense for them and their family?

Who Is Best Placed to Answer These Questions?

Most employees could probably not answer all those questions.

And that is not because employees do not care. Medical aid is complex, the language complicated and the rules intricate. The choices are not straightforward.

Often the person employees turn to first for clarity, is HR.

Creating an Awkward Situation

Imagine an employee walking into the HR office and saying:

“Why didn’t the medical aid pay my specialist?”

Another asks:

“We are having a baby next year. Should I change plans?”

Someone else says:

“My premium has gone up. What am I actually getting for the extra money?” or “Why did I have to pay a co-payment at the hospital?”

HR is expected to help but not required to be medical scheme experts. They have employees to support, policies to manage, compliance to deal with and a myriad other things competing for their attention.

So, what usually happens is that the employee gets sent to the medical scheme. HR becomes the middleman. And somewhere between the scheme, the employer and the employee, something important gets lost.

Do Not Lose Sight of the Value of the Benefit

Think about what your company is spending on employee benefits. It could be substantial.

Yet the conversation often centres around how much did the premium increase.

That is understandable, but also a little short-sighted.

The more important question is whether your employees are getting the value from the benefit you are paying for? Because a benefit can be incredibly valuable on paper and still feel disappointing to the person receiving it.

An employee who does not understand their medical aid plan sees a deduction and only discovers its limitations when they need treatment. On the other hand, an employee who understands what that plan protects them against sees a tool that help manages the risk should a serious medical situation arise.

This is Where the Annual Medical Aid Presentation Should Change

Your medical aid broker or adviser should not simply be facilitating the annual renewal. It should be more than running through the new premiums, reading the benefit changes and telling employees to submit their selections before the deadline.

Your employees deserve more than that. They need to understand what has changed, what they are paying and what they are getting for that. Is their current option still the right one for them? Further, they must be aware of the pitfalls when not using their medical benefit optimally.

That is not simply communication. It is education and helping employees make better decisions with a benefit that has a very real financial and personal impact.

Another Uncomfortable Question for Employers

If you are spending significant money providing medical aid, but your employees do not have a proper understanding of the benefit, how much of that investment is being realised?

And when employees are looking for someone to turn to when they have a difficult benefits question, is HR really the right place for them to go?

HR should not have to become an employee benefits specialist. That is what a good employee benefits adviser is there for: someone who can sit alongside HR, explain complicated matters in plain language, help employees make informed decisions and step in when questions become more technical.

This support should not only be available when the annual presentation comes around. It should be there when an employee needs help, a family is trying to choose the right option, a claim does not make sense and a benefit is misunderstood. An adviser with the right specialist knowledge gives HR someone to turn to when employees need clear, informed answers.

Offering the Benefit is Only the Beginning

The real question for employers is whether their workforce understand the benefit and value it. Whether they know how to use it and whether they know who to turn to when they do not.

Not sure your employees fully understand their medical aid benefit? A conversation with the right medical benefits specialist can help identify where the gaps are and how to close them. We offer a free 20-minute review with your HR team — no obligation, just a practical discussion about what your employees need to know and how you can support them.