What exactly is Medical Aid?

Medical aid is a form of insurance, similar to other forms of insurance such as motor vehicle or life insurance. Medical Aid can provide coverage for a person’s medical expenses. Medical aids differ from each other based on price, the level of benefits provided and the exclusions (what they do not cover) in their policies. This article compares different South African medical aid providers to help you make an informed decision when choosing which one to go with.

Medical Aid is a very important part of the South African healthcare system. In 2014, medical aid membership in SA increased to just over 14 million people, which is about 44% of the population. Medical aid companies offer basic health care coverage for an affordable monthly fee. But what exactly does this cover? And who qualifies for a medical aid? Find out below!

Medical Aid can be defined as insurance that provides basic health-care services to eligible people. Medical aids can be either private or public, depending on the country they are based in. (Some countries don’t have state medical aid.) In South Africa, all medical aid companies are at this point private, as the government has their own public health program.

Medical Aid covers all medical expenses, including:

  • Pharmaceuticals (including over the counter medicines)
  • Therapies and surgeries (including all consultations and procedures from a doctor)
  • Any other medical service needed. Medical aids that cover medical travel are not included as part of medical aid. For example, an HIV specialist appointment will be covered by the health insurance plan of the South African government. But if a patient needs to travel to their specialist abroad, this is not covered by medical aid no matter how much it costs and no matter what public assistance is offered because such treatment does not fall under the terms of the health insurance policy that applies to such patients.

Different medical aid policies provide different levels of cover. The level of cover depends on what the policy includes in the terms. There are different medical aid policies for different areas, such as adults and children, and for specific diseases such as cancer or diabetes. The most common medical aid plans across providers are hospital plans, and comprehensive plans.

Hospital plans cover in-hospital expenses only. The patient will not be covered outside of the hospital unless they have a secondary policy such as a comprehensive policy. The Comprehensive Plan has coverage for all areas, including outpatient treatment, private nursing care for chronic conditions outside of hospitals, optometry costs and physiotherapy.

Comprehensive Medical Aid Plans are a popular choice because they cover the entire cost of health-care, and the patient will no longer be required to pay for treatments which are covered by their health insurance plan. Each medical aid company has its own specific eligibility requirements for medical aid. The main benefit of comprehensive cover is that it can be a more affordable option when medical emergencies or planned procedures arise.

In order to chose the best medical aid, consumer should look for a provider who offers a wide range of products covering specific areas, such as maternity, orthopedics or cancer. This will ensure that the medical aid covers the most important things and the consumer can pick and choose which policy is right for them.

As mentioned before, all medical aid companies in South Africa are private providers. The only exception to this rule are medical aid funded by government such as the National Health Insurance (NHI). There are three organizations that oversee health care in South Africa:

Medical schemes—medical scheme companies pay healthcare providers directly for services rendered on behalf of their members. In South Africa, this is provided by the SABSA, which is a private, publicly owned health insurer.

Hospitals and health clinics—Hospitals and medical facilities across South Africa are owned by local municipalities.

Medical aids— Generally very well run and transparent, as they are directly overseen by the National Treasury. Medical aid generally offers comprehensive cover in most areas of medicine such as maternity and orthopedics; but they require higher premiums than public hospitals to provide this level of cover. Since April 2013 there have been many changes when it comes to how medical aids cover different areas of medicine.

How to choose a good medical aid?

Making the right long-term financial decisions can be difficult, not to mention time-consuming. But taking the time to compare medical aid providers can have a significant impact on your family’s overall health and welfare for years to come. This blog post will help make your decision easier by providing information about how you can choose a good medical aid that fits within your budget without compromising quality.

The cost of healthcare has been constantly rising over the last decade and these expenses are often unpredictable and unavoidable for many people living with chronic illnesses or pre-existing conditions. Increasing the rate of premiums for individuals and families to help pay for increasing costs in medical care can be hard for anyone to swallow. However, if you are willing to search for alternative options, it is possible to reduce costs without lowering the quality of care you receive. The best way to ensure that your medical expenses won’t put a strain on your budget is by choosing a good insurance company that has low premiums but excellent customer service.

Before making any final decisions about your family’s health insurance, it is important that you check around to find out which providers have the best customer service and are offering quality care at reasonable prices before settling on any one company.

In order to find the best medical aid deals, one must be able to compare the services of various providers. It is best to use a medical plan comparison tool to make sure that you are making the best decision for your family’s health and financial future. BetterMoney’s free Medical Aid Comparison Engine allows you to compare medical aid policies from dozens of providers side by side. By entering simple preferences and details of your family, you can find out which companies provide the lowest premiums, highest quality of care and best customer service. You can even get a quote online to make sure that you are getting the best deal.

Another benefit to comparing medical aid providers is making sure that your benefits cover the services and treatments you need. There are many different types of benefits offered by medical aid providers; however, not all treatment options are available with each medical aid plan. To make sure that you are getting all the benefits and options you need, you should take the time to compare medical aid benefit packages thoroughly before signing up with any one provider.

By using a medical plan comparison tool, not only will you be able to find out which providers can best meet your needs, but you can also search for affordable policies including medical aid and prescription drug coverage plans that can help reduce the cost of your healthcare. Good health doesn’t have to break the bank!

Comparing South Africa’s Top Medical Aids

Details on how to compare medical aids for South Africans are listed below:

  • What are the advantages and disadvantages of each medical aid and policy?
  • Ask questions about anything that you do not understand.
  • Look out for hidden costs in the documents you receive e.g., administration fees from your manager, account charges at your bank, etc.

Discovery Health

Discovery Medical Aid is a full-scale medical aid company which offers a number of health insurance plans, depending on the individual needs of each client. It also entitles its clients to cover extras like gym membership and fitness classes. The rates are cheap but it’s important to note that you must pay first and then wait 30 days, according to their policy, before claiming your money back if the plan proves ineffective. Discovery has several plans offering comprehensive cover for different age groups. Their plans entitle you to a personal account and medical discount cards which can be used at participating clinics and pharmacies for discounts on consultations, medication and even special procedures like laser eye surgery. This will reduce your medical treatment costs significantly. They have their own in-house telemedicine services, which can be used in remote areas without a doctor present. They also have a 24 hour medical aid call centre. The Discovery Vitality Program offers you a point system which will entitle you to various incentives like discounted airline and hotel tickets, free cinema tickets and even cash back if you’re a game player. Other providers like Discovery Vitality also give discounts on their products and services (and even other companies’ services) to Vitality members. This brings down the overall cost of living and makes the medical aid more affordable.

Bonitas Medical Aid

The Bonitas Medical Aid Plans offer lots of options and cover a range of medical services. Monthly contributions range from R594 to R3146, depending on the plan you choose. Plans start at minimal coverage and work their way up to more extensive coverage depending on monthly contributions. Bonitas has two separate medical aid plans, one for domestic and the other for international. Both plans are available through Bonitas’ website. Plans are only offered to residents of South Africa. There are no restrictions on income status or whether a person is employed or unemployed. Bonitas is a well established company and provides insurance solutions to more than 1.2 million individuals in South Africa each year. Currently Bonitas is one of the largest medical aid schemes in South Africa.

Bonitas Medical Fund is a South African Medical Aid Scheme. They have a variety of plans for individuals and families, as well as a medical aid plan for businesses and associations. Bonitas is the largest medical aid scheme in South Africa. Bonitas will pay up to 80% of the medical expenses you incur for any illness, surgery or hospital stay. Bonitas covers you for most common illnesses including cancer, diabetes, heart disease and other chronic diseases. There are fewer exclusions than in most insurance policies and Bonitas even covers repatriation fees when you’re abroad for medical treatment. Bonitas is the only medical aid scheme in South Africa that provides coverage for non-emergency conditions such as cataracts, weight loss, pregnancy and maternity care. Bonitas strives to make sure you have access to healthcare services. If medical coverage is unaffordable, they will provide you with a system of financial aid. There are many different types of plans available to choose from. Each plan contains options ranging from basic coverage to very comprehensive coverage.

Government Employees Medical Scheme

GEMS (Government Employees Medical Scheme), is one of the most established and largest medical aid providers in South Africa. The company provides medical care for a broad range of health and wellness needs including chronic, acute and preventive. GEMS has a large network of doctors, hospitals and dental professionals who make it their mission to provide excellent quality healthcare with empathy, care and dignity. The mission of the Government Employees Medical Scheme is to be the leading medical aid scheme in the Republic of South Africa, and to be recognised by its members as a responsible, caring and professional organisation. It provides services for employee groups of the public sector, private sector, churches and NGOs.

KeyHealth Medical Aid

KeyHealth is a well established medical aid provider in South Africa. KeyHealth Medical Aid was created to meet the needs of the changing South African healthcare system, an evolving marketplace that is in need of a health insurance company that is flexible, innovative and able to offer products across all different tiers of cover. The company bills itself as the cost-effective option for people who want to take care of their families’ medical expenses, offering a wide range of basic products. Patients can also upgrade their KeyCover Medical Aid plans in order to receive more comprehensive coverage as part of the KeyLIFE Plan range for premeditated or catastrophic events.

Momentum Medical Aid

Momentum Medical Aid offer a host of services to their clients, some of which include cashless health care and contactless medical services. They also offer personalised products like pension funds, and investments in the Momentum Mutual Fund. The Momentum Medical Aid is managed by Momentum Healthcare Limited. It provides medical aid cover to the large segment of the South African population which does not have access to medical aid. It is a comprehensive healthcare service that offers all services in an integrated package, including out-patient care, outpatient care, emergency care and inpatient care.

In its financial year end 2008 results statement, Momentum Medical Aid reported a loss of R4.1-million. However, this was mainly due to extraordinary payments relating to a one-off restructuring exercise necessitated by the government’s recent announcement of its intention to change the lay health provider regime. The company reported an operating profit of R70-million in 2009 and has enjoyed a growth rate of more than 5% from 2009 to 2010.

Momentum Medical Scheme was founded in 1981, and currently has over 1.7-million members. It consists of the Momentum and Momentum-Mediclinic schemes – Two separate schemes under one corporate umbrella. They are all accredited by the Financial Services Board as a medical aid scheme, which means they are registered for the purposes of providing health insurance on a collective basis to persons who have satisfied conditions laid down in any applicable law regulating health insurance from time to time and as approved by the Financial Services Board. These schemes are designed for people who are not covered by any other medical scheme or who are paying at their own cost. The company is headquartered in Epping, Johannesburg and has over 500 branches all over South Africa.

Medical Aid for Pensioners in South Africa

If you are a pensioner in South Africa looking for medical aid, you may ask yourself if you are even eligible, and if so what is the best medical aid for pensioners. With changing regulations and companies sprouting up products all over the place, it can be difficult to find which one is the best one. Here we will look at whether or not you are eligible for medical aid, what benefits you may get from each company, as well as how to apply for medical aid.

Are you eligible for medical aid? If you are over the age of 60, retired or have a disability, you may be eligible to apply for medical aid. The South African Medical scheme expanded its coverage in 2002 to accommodate retirees. This was done to make sure that seniors and those with disabilities would have access to comprehensive medical care in an environment where they would not be alone. Prior to this, most medical aid schemes did not cover seniors at all. Pensioners become eligible for medical aid from that age, however many companies will require proof of pension. Documents you will have to provide include your National Insurance number or your pension slip, and proof of age. If you are unable to provide them, they may request a letter from your local authority.

What benefits may you expect? The South African Medical Schemes Complaints Council has guidelines for the industry on what benefits pensioners are entitled to. These guidelines include:

  • A lump-sum of R1,500 a year each for health and medical expenses in the event of hospitalisation, regardless of the level of cover. This can be used to pay for things like admission and accommodation fees. This also covers other services such as physiotherapy and occupational therapy. There are certain criteria that must be met. These are outlined on your policy document.
  • Use of a private hospital or clinic (you will be asked to pay for the privilege). This can be used for things like theatre, intensive care and elective surgery. However, if you require more extensive treatment, you may have to use a public hospital.
  • Staff costs such as salaries for nurses. If your insurer requires this information then it must be provided at the time of application.