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Why is my Medical Aid not paying for my Spectacles?

We all share the same frustration. We contribute an arm and a leg towards our medical aids each month, and then, when you need them the most, they disappoint you!

We are partly to blame for this dilemma. Ask your friends to explain how much their medical aids pay for spectacles and you will be surprised to hear that they do not know! They may also mention that their optometrist will have that information available when they go for a consultation.

The young and healthy professional girl that is on a comprehensive cover plan may boast that her medical aid pays for everything, even sunglasses and contact lenses. Is she lying? No! She is just lucky enough that she had no health issues this year and that there are enough funds available in her day-to-day savings to pay for her optical goods. You, on the other hand, have three children that all recently had flu and that severely depleted your savings.

Not all medical aids cover optical goods from day-to-day savings. There are medical aids that allow one pair of spectacles every two years. They will allow for four boxes of contact lenses too, but not in the same year! If you want them to pay the bill, you will have to use the goods that they dictate. They may refuse to pay for multifocal lenses but allow (unsightly) bifocal lenses. This specific government medical aid allows R4 270 for optical goods per family every second year. It might cover the needs of one patient, but if you have a family of four all in need of vision care, that limit is not enough.

Does it mean that I have a ‘bad’ medical aid if they only allow R4 270 for my optical needs every two years? No, it’s not the medical aid that is bad. It is the way we perceive their role in this matter. Medical aids do not PAY for eyewear, they merely CONTRIBUTE towards it. Fair? Let’s discuss it.

Optical frames have become a fashion statement. Our different lifestyles require various optical solutions. More and more ladies (especially) find that having only one pair is just not enough! The stern black pair, perfect for the suited outfit in the office, is just not fun enough for weekends when a funky, colourful round frame is needed. And what about prescription sunglasses and contact lenses or even coloured contact lenses? Moreover, then there are different types of lenses.
Why should you wear unsightly bifocal lenses just because it is stipulated in your medical aid terms and conditions? These are the things we WANT but not necessarily NEED.

Can we expect medical aids to pay for all of this? Probably not!

Different people have different needs. Two same-aged teachers in the same school with the same medical aid and the same prescription will have different opinions of their fund. Teacher one will be more than happy with a pair of readers to use for close-up work that is fully covered by her R4 270 limit. Teacher two refuses to look over her frame and prefers a multifocal pair for all-day use. Because she is going to wear her spectacles all-day every day, she expects a frame that will compliment her face with anti-reflex coating added to the lenses.

These are the choices you have to make. Are you going to wear a cost-effective frame that you do not like with lenses that are unsuitable for you for the next two years? Once you understand that medical aid only contributes enough towards your eyewear to solve your basic visual needs, the decision will be much easier to make. You will be ready to make your contribution towards the eyewear that you WANT to wear and that will suit your lifestyle.

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