Choosing the Right Medical Aid in South Africa

Choosing the right medical aid is very important. How do you choose a medical aid in South Africa?

Medical aids schemes assist members, enabling them to afford the necessary medical and hospital treatment required. South Africa provides two main types of medical aid schemes, open schemes and closed schemes.

Open and Restricted Medical Aids Schemes

What is the difference between open schemes and restricted medical aid schemes?

Open medical aids schemes are available to any South African, while restricted medical aid schemes are limited to employers and employees of specific companies, industries, unions, professions, or academic qualifications.

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Examples of restricted medical aid schemes (this is not a comprehensive list):

· Bankmed

· Old Mutual Staff Medical Aid Fund

· Gems Medical Aid

· Profmed

· SABC Medical Aid Scheme

· Sasolmed

Examples of the 26 medical aids that are open (this is not a comprehensive list):

· Bonitas Medical Aid

· Discovery Health Medical Scheme

· Medihelp

· Pharos Medical Plan

· Pro Sana Medial Scheme

· Selfmed Medical Scheme

· Suremed Health

· Sizwe Medical Fund

Differences in Medical Aid Schemes

There is one great difference between all medical aids in South Africa. Each medical aid has its features and benefits. Each plan or package within the scheme has a certain level of comprehensiveness. The main feature is what is covered and to what extent, specifically coverage of specialists, treatment and tests when hospitalized and as an outpatient.

Probably the greatest mistake you can make is to think you are healthy and to ignore the need of a medical aid. Then when the inevitable happens, and you need an operation, or a family member requires emergency treatment, there are no funds to cover the bills of the hospital, doctors, X-rays, blood tests, or intensive care.

There are many sad stories of families losing their home to pay their medical bills. This is definitely one of the situations of rather being safe than sorry. It is then too late to subscribe to a medical scheme thinking your bills will be covered. All medical schemes have certain requirements and there are waiting periods for coverage of certain treatments.

People grow old. It is unwise to wait until you retire or need a medical aid to subscribe to one then. There are penalties involved if a person has not belonged to a medical aid from 2003. When you choose a medical aid, take into consideration the features and benefits it has regarding frailty care and other health support for pensioners.

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Different Rates Apply

The National Health Reference Price List, or NHRPL for short, is the basic costs medical aids determine yearly. This is the basis of the medical aid rates that your medical aid is prepared to pay towards your healthcare. Each aspect of health has different codes referring to the NHRPL.

When you visit a private doctor or go to a private hospital, for example, it is essential to determine what their rates are. The rates can be as much as three times the rate determined by the medical aids. That is why it is important to find out from your medical aid to what extent the treatment or hospitalization bill will be covered by the medical aid. This should be done before the specific health care is provided.

Often there are shortfalls between what the medical aid covers and the remainder of the bill. Many medical aids have additional plans, a gap cover plan, that is added onto your specific plan to cover the remainder of the bill. It is normally a savings type of plan. The conditions differ from medical aid to medical aid.

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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.