Medical Aid in South Africa

Medical aid in essence is a type of insurance that pays for private medical costs should you fall ill, require emergency medical treatment in a hospital or are involved in an accident. (Read the Top 10 facts about Medical Aids in South Africa.)

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Private medical costs are staggering a birth is a private hospital will cost up to R100 000, that is more than the average person earns in a year.

How it works

With medical plans you pay a monthly premium to cover your medical costs and specific medical needs. All these premiums are combined to cover all the scheme’s member’s projected medical costs.

In essence it is a high level budgeting system that estimates the annual risk of all the member’s medical expenses. This is calculated by looking at the past expenses and expected increases of the cost of health care in the future. A financial structure is set up to ensure that they have enough money available to pay for all the benefits the members receive.

The estimation considers how much the members claim, what is claimed for and the cost of the medical treatment. This estimation indicates to the medical aid schemes how high the premiums of the members should be. The more cover you require the higher your premium will be.

These costs are calculated annually when the next year’s medical cost structures are published. Thus your premium will increase annually as the medical costs increase.

Some factors to look out for when deciding to purchase a medical aid plan:

• Exclusions: Some companies have exclusions on existing conditions; these exclusions can last up to a year.
• Waiting periods: When you acquire a medical aid, some companies have a waiting period of three months before they start paying for certain claims.
• Benefits: Ensure that all the benefits you receive will suit your needs, an active person participating in sports might have need of higher radiology and physiotherapy benefits, and a member with a family history of cancer might look into higher oncology benefits.
• The claims process: Some companies require the members to pay deposits for procedures where other companies do not have this deposit requires. As with claims, you do get aids that require you paying the bill and claiming from them instead of the service provider placing the claim.
• Bonus features: Some companies offer bonus features like magazines and gym subscriptions, Should these not fit your lifestyle consider something that does not include these features.

Understanding how it works and what medical aid in South Africa is, will help you to make an informed decision should you consider medical insurance in future. © Medical Aid Plan

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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.