Every medical aid has several options to suit different budgets and individual needs or preferences. These options are known as plans and are pre-structured. In this way a prospective member can choose the best medical aid option for themselves and their family. Medical aid options cannot be tailor made for an individual – you need to select from the existing plans. However, many medical aids or affiliated insurance companies now include additional options like gap cover which will make up for any shortfalls within a specific plan. Understanding the difference between medical aid options is important in making a decision on the cover that bests suits you. Price should not be the only factor and one option may not suit another depending on individual and family health care needs.
Changing medical aids is a not a difficult task provided that various procedures are followed to ensure that it is done properly. The greater challenge lies in taking the risk of changing from one medical aid to another and whether this will work in your favour or not. Many medical aid members make decisions rather impulsively, blinded by the price factor, with little thought of how changing medical aids can impact on their cover. While it is always good to shop around, one should not be hasty in making a decision without first comparing the benefits of the new medical aid plan with that of the old one. After all, you either need the same cover or better cover over time as you get older and the risk of various diseases increase.
Reading through your monthly medical aid remittance can often be confusing with columns of codes that makes little sense to the average person. These tariff codes are a standardised means by which medical aids can communicate with each other, healthcare practitioners and other service providers. It removes the need to describe each consultation, medication or procedure in English or any other language as these codes are universal among all medical aids in South Africa. Although most remittance advices have a description of the service rendered, medication prescribed or procedure conducted, it is important for the medical aid member to understand the relevance of these codes and how it may affect their medical costs.
Joining a Medical Aid After Falling Pregnant
Medical aids usually do not cover any procedure or treatment for a pre-existing condition within the first year of joining a scheme. This applies to pregnancy as well and almost all medical aid schemes will not cover the pregnancy and delivery costs for a new member who joins the scheme when pregnant.
The list of registered South African medical aids was sourced from the Councils of Medical Schemes website. Some of these medical aids may have discontinued business or changed their contact details. This list serves as a guide and Vitacare Health will not be held liable for any incorrect information. Always refer to the medical aid’s website or phone the call centre for more information. New medical aids may not be listed here.
A restricted medical aid means that only employees of a certain company or workers of a specific sector of industry can join the medical scheme. It is not open to the general public. Always refer to the contact numbers on your latest medical aid card for the most up to date details. Your medical aid may have different contact numbers for general enquiries, hospital authorisation and emergency services.
Deciding on whether to opt for full (comprehensive) medical aid cover or a hospital plan only, depends largely on the individual and one’s budget. A hospital plan is more affordable and offers protection for the most expensive of services – hospital care. However, one’s medical needs may not require hospitalisation and can still be costly to the point that it can be unaffordable. In this respect, comprehensive cover or full medical aid cover offers the best of both worlds. Fortunately recent changes in private healthcare legislation has now offered the consumer, even those without full medical aid cover, the protection for certain life-threatening chronic ailments.
