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Choosing a Medical Aid in South Africa


 

  

  

Cape Medical Aid

Cape Medical Aid offers its services to everyone in South Africa, not just in the Cape.

Cape Medical Scheme has three plans to choose from, the HealthPact Premium Plan, HealthPact Silver Plan and the comprehensive HealthPact Select Plan.

Cape Medical Aid

Founded in 1961, this medical scheme has regional offices in various cities throughout South Africa. The head office is based in Cape Town. Good communication with members is very important, and they promise to react promptly on any enquiries made. They also keep you up to date with information of what is happening in healthcare in South Africa.

The medical aid offers three plans, formulated in such a way that it covers medical needs and is seen as an affordable medical aid.

HealthPact Premium Plan

The Healthpact Premium Plan is the basic health plan for the healthy individuals who are not diagnosed with chronic diseases. Hospital cover has not limits and 200% above medical tariff rate are covered when visiting specialists. Certain procedures require approval prior to the operation or procedure. There are no limitations to which hospital to go to, you can go the hospital you prefer.

A slightly unique edge to the hospital plan is the coverage of certain medical treatment and procedures out of the hospital. It is however recommended that you check first to ensure whether the treatment you need, is covered by this plan. Pathological services have no limits and the scheme is generous with benefits to maternity patients. It also covers emergency ambulance services.  

HealthPact Silver Plan

The HealthPact Silver Plan includes a medical savings plan. This gives members the opportunity to manage their out-of-hospital expenses for medical treatment. Included are visits to a dentist, a general practitioner, optometrist and the over-the-counter medicine required. This plan also requires approval prior to the specific hospital treatment or operation.However hospitalisation is unlimited.  

HealthPact Select Plan

The HealthPact Select Plan is the top of the range of medical aid schemesproviding comprehensive and outstanding cover. This plan includes the hospital plan and also benefits for patients diagnosed with chronic illnesses. You can go to the doctor of your choice as well as the hospital you prefer. The expenses for medical and health care out-of-hospital are managed by you, the member by using the savings account. 

Medical Savings Account

The medical savings account provides cover for out-of-hospital, day-to-day medical and health care. At the beginning of the year the account is funded with the amount you are allowed to use. As you draw from the account for these medical expenses the account depletes. Should your medical savings account run out of funds before the end of the year, you as a member will be liable for the costs. However, if you don’t use much of the funds during the year, the savings that are still in your account will be carried over to the next year.

Keep in mind medical aids such as Cape Medical Aid and Discover Medical Aid have certain limits what you can spend in each of the categories. For example, you can run out of funds for optometry, but have enough founds for a general practitioner. This is an important factor to take into consideration when choosing your medical aid.