Medical Aid Schemes
Despite industry developments adding to the pressure of medical aid schemes’ to stand and deliver, the financial cover these products offer policyholders makes every premium payment, money well-spent.
In recent times, medical aid schemes have constantly been under the spotlight as South Africa’s healthcare industry remains in a state of flux.
This can be attributed to two factors.
- The uncertainty about the advent of National Health Insurance.
- The ever-spiralling cost of private healthcare.
But despite these tribulations, medical aid schemes are soldiering on to constantly improve their offerings and to keep premiums as low as possible.
Survey identifies industry leaders
In a recent survey undertaken by the independent financial management company, GTC, several medical schemes earned 
recognition for their contributions to the healthcare industry.
A total of 22 medical schemes offering 272 different plans came under the spotlight. These were divided into four categories – Entry Level, Hospital only, Saver and Comprehensive.
Here, at a quick glance, you can view the top achievers.
Entry-level – low income-earners
• Compcare took the first three positions
• 4th Momentum
• 5th Fedhealth
Entry-level – mid-salary earners
• Compcare took the first three positions
• 4th Momentum swept the board with six category wins
• 5th Sizwe (1)
Entry-level – high income-earners
• 1st Bonitas
• 2nd Medshield
• 3rd Selfmed
• 4th Discovery KeyCare
• 5th Compcare
Hospital Plans
• 1st& 4th positions – Profmed
• 2nd Selfmed
• 3rd Genesis
• 5th Discovery Essential
Saver Plans
• Medimed took the top three positions
• 4th Bestmed
• 5th Topmed
Comprehensive Plans
• Fedhealth took the top two positions
• 3rd& 5th Discovery Essential and Discovery Delta
• 4th Momentum
(These rankings were based on total cost and risk ratings.)
Medical scheme myths
In a recent online news article, several interesting myths about medical aid schemes were put to rest.
Some of these included:
1. Myth: Medical schemes are profit-making machines.
Fact: Untrue. They are State-regulated and any profits are shared with members in the form of reserve funds.
2. Myth: I am forced to use network hospitals.
Fact: No, you are not. You can use any hospital you like but may then have to make a co-payment.
3. Myth: A scheme dictates what medicine to use.
Fact: No, it doesn’t. You may be encouraged to use medication on the scheme’s medication list but should you opt for something else you will probably have to pay in the difference if it is more expensive.
4. Myth: A medical scheme cannot cancel my membership.
Fact: Wrong, they can and will if you fail to make your monthly premium payments.
5. Myth: All cancer treatments are paid as a Prescribed Minimum Benefit.
Fact: Incorrect. While some forms of cancer appear on the PMB list, others do not. Oncology cover depends on your chosen medical plan.
6. Myth: Medical schemes drag their heels to settle claims.
Fact: No, they don’t. Any delays usually occur when policyholders fail to provide all the necessary documentation. If for some reason your claim is not paid, the scheme will be taken to task by the Council for Medical Schemes.
Affordable medical schemes
For most South Africans, affordability is of paramount importance.
The same premise exists when it comes to selecting a medical scheme.
Independent Financial Consultants (IFC) recently revealed a list of the most affordable medical schemes in the country.
These are as follows:
Schemes in the R1 000+ range per month
Ø Fedhealth Blue Door Plus
This is cover for lower income-earners and pays for major medical procedures at either network or State hospitals.
It also covers Prescribed Minimum Benefits (PMBs) such as organ transplants and renal dialysis at State facilities only.
Cancer treatments listed as PMBs are covered at the schemes’ designated service providers.
This plan also offers day-to-day benefits for medical consultations with specialists and GPs and includes basic dentistry, optometry, X-rays and blood tests at network providers.
Ø BonitasBonCap
This plan offers unlimited cover at designated network hospitals.
Momentum Ingwe Option
In-hospital benefits are limited to 100% of the scheme’s stipulated tariff rate, further limited to R1,19 million annually.
It also offers limited PMB cover at designated service providers, as well as chronic cover for 26 PMBs.
Ø Discovery KeyCare
There is more than one KeyCare option but generally, this plan offers day-to-day benefits at State facilities and network providers.
Other benefits include cover for mental health issues, MRI and CT scans, cataract surgery, dialysis and in-hospital treatment for drug and alcohol abuse.
Visits to network GPs are unlimited, as well as basic cover for dentistry, X-rays, optometry, pathology and day-to-day medicine.
Conclusion
There is an unlimited choice of medical healthcare cover to suit all
individual needs and pockets.
Consumers are urged to undertake due diligence before settling on a medical scheme by researching the many products available in the marketplace.
There is a medical healthcare plan out there to suit your needs.
NOTES:
Your medical aid quote will include options to suit your pocket. Please ensure that the cover you select is exactly what you need and that you understand exactly what insurance you are buying. Do not hesitate to ask questions about the medical aid or hospital cover you choose.