Joining a medical aid is always recommended especially if you have a family as the rising costs of private health care is not affordable for most South Africans. Medical aid cover will provide you with a sense of security and should any medical emergency arise, you can rest assured that your comprehensive cover will allow you the best medical services in South Africa. More importantly, it will spare you an experience in a South African state hospital which seems to be another important contributing factor for newcomers to medical aid services.
How to Compare Medical Aids
Choosing the right plan for yourself and your family is difficult but here are a couple points to consider.
- Will your employer subsidize your contributions?
- Does you employer have a staff medical aid option?
- If you are self employed, will you be able to get a tax benefit from your medical aid contributions?
If your employer subsidizes your monthly contributions or has a staff medical aid option, it is best to go with the in-house medical aid plan.
Depending on your budget, you can opt for either comprehensive medical aid cover with day to day, out of hospital benefits or a more cost effective hospital plan.
Day-to-day or out-of-hospital cover will pay for services that do not require hospitalization. This ranges from consultations with doctors and therapists to blood tests, acute medication and optometry benefits. Your medical aid may provide separate limits for each of these services or a total annual amount from which all out-of-hospital benefits are covered. Once this day-to-day limit is exhausted for the year, you will be responsible for all medical payments on your own on a cash basis.
Some medical aids provide a savings account which differs slight from a day-to-day cover. This savings account is a portion of your monthly medical aid premium and this money is essentially your funds that are being held by your medical aid for your out-of-hospital services. It is advisable that with a savings day-to-day plan, you should still pay all your medical aid bills upfront out of your pocket. You may then claim back the funds from your medical aid. This will allow you to get a cash discount from your doctor or pharmacy and you can rest assured that you have sufficient medical aid cover for longer periods in the year.
A hospital plan is a cheaper medical aid option that covers you for in-hospital services. It is ideal cover for a tight budget or any person who has sufficient financial resources to settle their day-to-day, out-of-hospital bills on their own. Prices and options may vary among medical aid schemes but here are a few points to keep in mind when deciding on the right hospital plan for you and your family.
- Is the hospital limit capped to a certain amount or unlimited? Unlimited may not always mean without any restrictions or exclusions so read the fine print. Psychiatric hospitalization, substance abuse and hospitalization for unknown causes may be capped to a maximum annual limit that is quite small.
- Does your hospital plan cover out-of-hospital chemotherapy or radiotherapy for cancer sufferers? Some hospital plans in South Africa do provide this benefit.
- Would you qualify for certain prosthetics with your current hospital plan? This includes cochlear implants.
- Does your hospital plan provide a chronic medicine cover? Many medical aid schemes now provide chronic medicine cover as part of a hospital plan.
Compare the rates and benefits among different medical aid providers. Cheaper is not always better and some medical aids may cost a little more but provide comprehensive hospital cover. You may even receive additional perks like gym membership, cash back on grocery purchases and budget holiday options.
Medical Aid Cover, HIV/AIDS and Chronic Conditions
Unfortunately many South Africans only join a medical aid once they develop a chronic condition like diabetes, cardiovascular disease or HIV/AIDS. While your medical aid does not require a blood test to identify health problems prior to you signing up on their cover, they do require full disclosure of your pre-existing health conditions. These chronic conditions will then be excluded from cover for the first year of your membership.
However if you fail to disclose your pre-existing chronic conditions or known HIV status prior to joining the medical aid, your medical aid may not pay for services should they discover that you were aware of these conditions and did not reveal it to them. While many new members with pre-existing conditions attempt to ‘beat the system’, there have been many occasions where the member had to foot massive medical bills due to refusal by their medical aid to pay due to non-disclosure.
Medical Aid Rates and Prices
Medical aid rates in South Africa differ significantly among the medical aid scheme, your plan of choice and services covered by the scheme. Medical aid cover may start from as little as R400 for a single person providing in-hospital cover with a chronic medicine benefit to R3000 per adult member on the upper level plans. Medical aid prices may seem exorbitant in some instances but if you weigh out your benefits should your require medical care, the monthly premium is minimal in comparison.
Most employers in South Africa subsidize medical aid premiums for their employees.Some employers will only provide added benefit if you join a specific medical aid for your industry or the company’s preferred provider. Your employer may cover between 50% and 66% of your monthly contribution and it is best to opt for the medical aid cover through your employer.
However if you are paying for your medical aid without assistance from your employer, you can opt for an “open” scheme. An open medical aid scheme means that any person can join the medical aid and is not industry or company specific.
Open and Closed Medical Aids
Some of the larger open medical aid schemes are Discovery Health, Bonitas, Fedhealth, Momentum Health and Medihelp. There are many other open medical aid schemes in South Africa offering very competitive rates. These rates may differ based on the plan you choose allowing you access to different levels of medical services.
A “closed” or restricted medical aid membership is solely for members of a specific sector if industry like GEMS for government employees or Polmed for the police services. The rates offered by closed medical aids may at times seem extremely competitive for the medical services being provided but it must be remembered that a closed medical aid is significantly subsidized by the employer and associated players in that sector of industry.
Budget Medical Aid Plans
Recently, most open medical aids have started offering lower end plans whereby an entire family can be provided with medical cover for a few hundred rands a month. These lower end, budget plans may not offer extensive medical services as the upper plans but you can rest assured that your basic medical needs are catered for. Usually these budget plans will only allow you to visit certain service providers, clinic or hospital networks as stipulated by the medical scheme.
When choosing a medical aid in South Africa, it is important to weigh out your medical needs and that of your family, consider the type of medical cover that you would require and any medical aid exclusions due to pre-existing conditions. Medical aid rates in South Africa are fairly reasonable considering the quality of private medical services. Choosing a cheaper medical aid plan due to price considerations may often leave you frustrated and in despair when you require medical care.