Vitacare Health

A medical aid is a form of health insurance where the scheme covers the costs of your medical needs. Should you require medical attention, you can visit a doctor or a hospital and your medical aid will pay for most, if not all of your medical expenses. In South Africa, your medical aid will often pay your doctor or the hospital directly for your medical expenses provided that your practitioner is contracted into medical aids.

A medical aid should not be confused with hospital insurance plans that are available through most insurance companies. Hospital insurance plans reimburse you at a set rate for every day that you are in hospital. This is meant to assist with your daily expenses when you cannot work due to hospitalisation and cannot offer you the same level of protection as a medical aid.

Medical aids differ in their benefits so it is important to understand your options carefully. In South Africa, the market is quite flooded with medical aid providers and it is often difficult to choose the right medical aid and plan for you and your family. Most medical aids provide three main benefits – out-of-hospital (day to day) cover, chronic benefit and in-hospital benefit.

Here are a few points to bear in mind when shopping around for a medical aid :

1. If your company is providing or subsidising a medical aid of their choice, it may be more feasible to opt for this medical aid.
2. Do not wait too long before joining a medical aid. You may have to pay a late joiner fee if you are over the age of 35 years and certain chronic conditions may be excluded for the first year of cover (read Medical Aid Scheme Exclusion). If you do have a chronic condition before joining your medical aid, make sure that you understand all the restrictions relating to this condition.
3. Even if a comprehensive medical aid cover is not affordable, at least consider a hospital plan. These options usually provide both a chronic benefit as well as an in-hospital cover which are the most costly of your medical expenses.
4. Always disclose your full medical history. In the event that your medical aid discovers that there was not full disclosure, you can be held liable for exorbitant medical bills that you had thought would be covered by your medical aid.
5. Verify whether the medical aid will only pay for certain doctors and hospitals of their choosing or you can choose your practitioner and hospital. Many medical aids have plans that will only pay for medical treatment at specific doctors, clinics or hospitals (network service providers). These plans are often more affordable and you will still get great medical care but it can be inconvenient at times.
6. Ask your medical aid if they will pay NHRPL (National Health Reference Price List) rates or SAMA (South African Medical Association) rates for your doctors. There is a significant difference between these rates and while all medical aids do pay NHRPL rates, not many may pay SAMA rates. Unfortunately many specialists now charge SAMA rates and you may be liable for the difference.
7. All medical aids in South Africa are governed by strict legislation so do not believe stories that you may hear about medical aids ‘ripping off’ their clients. The reality is that you get what you pay for like anything else in life and your medical aid will take care of you as per the policy you have purchased.


8. If you wish to switch over from one medical aid to another, inform both companies accordingly. It is illegal to be on two medical aids at the same time and both medical aids can refuse to pay for your medical expenses if you contravene this law.
9. You may choose a medical aid based on the lowest monthly premiums but in the long run this may not be value for money. Choose a reputable medical aid scheme and even if you are paying a little more, you may find that some of the perks and benefits of the scheme make it quite a wise buy.
10. Always enquire about the limit for less common benefits like chemotherapy, implants and psychiatric illnesses. These benefits need to be substantial if you do need to use it.

Related articles :

1. Medical Aid Exhausted – Insufficient Funds
2. Family Medical Aid
3. Affordable Medical Aid
4. Medical Aid Suspended – What does it mean?
5. Student Medical Aid