By: Martin Rimmer, CEO of Sirago Underwriting Managers

Health insurance planning is a critical aspect of overall financial wellbeing, particularly for women who face unique health needs and risks throughout their lives. For a start, women typically live longer but often earn less than their male counterparts. The longer life expectancy means that women could face greater financial burdens when it comes to affordability of private healthcare, especially so during retirement. Women are also potentially at greater risk for specific diseases that can lead to a major health crisis such as breast, ovarian, and cervical cancers. Women also typically take on more family responsibilities and are more likely to have breaks in their careers to take care of children and even ageing parents.

“It is these nuances in the income and lifestyles of women that need to be considered in your healthcare financial planning. In an increasingly difficult financial environment, the gaps in income, savings, and affordability are widening, forcing many women into trade-offs between taking care of their immediate living needs and those of their families, and planning for an unknown health event in future. In measuring the implications of these trade-offs, it is especially important to get professional advice from a qualified healthcare broker who can help find the balance between affordability and budget right now, as well as ensuring access to private healthcare when you need it most,” explains Martin Rimmer, CEO of Sirago Underwriting Managers, a gap insurance provider underwritten by GENRIC Insurance Company.

Key considerations for healthcare financial planning for women

Sirago highlights some of the key considerations that women need to consider in their healthcare financial planning:

1. Medical scheme cover – Given the high costs of private healthcare in South Africa and the parlous state of public health services, there is little doubt about the importance of having medical scheme cover and access to private healthcare. Talk to an accredited and professional broker who will thoroughly investigate your medical scheme options in line with your budget and healthcare needs. Your broker will analyse your current day-to-day healthcare expenditure, claims history, whether you or your family have pre-existing, chronic conditions and then measure this against which benefits will provide sufficient cover. Cost consideration, should not always influence the decision making as the healthcare needs if not effectively considered could be financially debilitating because of been on the wrong option.  The role 0f the broker will be invaluable in helping you get the best cover that you can afford / need and understand what potential out-of-pocket shortfalls you could face and how to plan for self-funding them.

2. Gap Cover – As a supplementary cover that works hand in glove with your medical scheme benefits, gap cover is the invaluable safety net that covers the shortfall between what medical schemes pay and what specialist doctors charge. Without this, policyholders may find themselves paying for unexpected costs from their own pockets. Specialists and in-hospital charges can be up to 400% more than the benefits offered by your medical scheme. So, if your medical scheme only pays out 100% or 200% of tariff for your hospitalisation and in-hospital treatment, you will be liable for the shortfall of the remaining 200-300% out of your own pocket. Most medical schemes also have deductibles and co-payments which you may be liable for upfront – these can be especially marked on lower benefit options and leave you in a serious financial predicament. Sirago’s average “large loss” gap claim now sits at around R40-60k shortfall, making gap cover an absolute essential consideration.

3. Make financial provision for a health crisis or disability: The impact of a serious health crisis or disabling event can have a huge impact on you, your family, and your ability to earn an income. A health crisis such as cancer may mean you are unable to work for months on end, which could leave you without an income. If you’re a stay-at-home mum, there are significant responsibilities you take on from ferrying children, providing academic support and teaching, being the major caregiver to children and ageing parents and so on.  These responsibilities have a significant financial impact attached to them if you need to find a trustworthy caregiver to take over these responsibilities. Speak to a professional broker about insurance solutions such as income protection, disability, and critical illness cover to protect you and your loved ones should you ever face such a health crisis.‍
4. Do preventative health checks – Commit to your preventative health checks every year. This way, you ensure that any diagnosis of a potential health crisis is caught early and this will have a significant impact on reducing the health, emotional, and financial consequences. Check with your healthcare financial advisor what your health insurance plan covers in terms of essential preventive care such as mammograms, pap smears and bone density tests.

5. Maternity and Reproductive Health – If you’re planning to have children, prioritise a medical scheme or health insurance plan that offers comprehensive maternity and reproductive health benefits. The cost of childbirth can be substantial, and significantly higher if there are complications. Key considerations to look at include adequate coverage for prenatal visits, screenings, and postnatal care for mother and baby.

6. Got a chronic condition? Women are more likely to develop certain chronic conditions, such as autoimmune diseases and cardiovascular diseases. According to the American Heart Association, cardiovascular disease is the leading cause of death for women, causing 1 in 3 deaths each year. If you have a chronic condition, then your healthcare financial planning is even more important to ensure that you have coverage for visits to specialists as well as the medication necessary for managing chronic illnesses on a long term-basis to avoid significant out-of-pocket expenses.

7. Get serious about a healthier lifestyle – Small and consistent changes to your lifestyle can have a huge impact on your overall health and finances. Drink less alcohol and more water, eat healthier foods, kick your smoking habit for good, exercise for a few minutes every day, and take care of your stress levels and mental wellbeing, especially during tough financial times.

8. Make use of group employee benefits – If you have access to employer group benefits, make use of them as they typically come at a lower premium due to the leverage of group buying power.  Talk to your broker about the interplay between your individual and employer-provided healthcare benefits and make sure they work cohesively and that there are no gaps or duplications.

“Healthcare financial planning is important regardless of your gender, however there are certain considerations and conditions that disproportionately affect women and that should be factored into your planning and budget. The advice of a professional healthcare broker is critical in helping you navigate through these important considerations and find solutions that meets your needs and budget,” concludes Rimmer.

For more information visit: www.sirago.co.za