choosing a medical aid

Choose Affordable Medical Aid.
The types of plans and benefits that are available in South Africa.

help with medical aid

Choose the RIGHT, AFFORDABLE medical aid plan to suit your needs and budget.

A medical aid is like a mutual society or stokvel...where all the members support one another.
Younger members, who are more healthy and claim less, subsidise older members who are unfortuate enough to have poor health.
However, young members may have high costs to meet, like maternity and children.

YOU DO NEED MEDICAL AID!
The cost of a few weeks in intensive care following a car accident or stroke can occur at any age and can cost hundreds of thousands of rands. And what if you have to use a government hospital!

A good medical aid plan means that you can rest assured knowing that your medical costs will be paid in all cases that require private hospitalisation.
Choose the right medical aid that will give you access to high-quality medicines, especially in the case of chronic long-term illnesses.

PRESCRIBED MINIMUM BENEFITS

All schemes must provide you with certain minimum benefits, the prescribed minimum benefits (PMBs), which cover:Schemes can specify that you use a particular provider - the designated service provider (DSP) - for PMBs and can impose co-payments or deductibles
(the part of an account you must pay from your own pocket) on PMB claims, if you do not use the DSP - except in an emergency, or if the provider was not available -
or was not reasonably close to where you live or work.

Medical aids can add WAITING PERIODS for new members. Either three months or a year, during which benefits are denied or restricted.

LATE JOINER PENALTIES are also imposed. This is a loading on contributions for those who join a medical scheme after the age of 35 and have not previously
been a member of a scheme for a specified number of years.

WE CAN ADVISE YOU AS WHAT THESE MAY BE.


choose medical aidChoose the right plan, with the right benefits for you.




WHAT DIFFERENT BENEFIT OPTIONS OFFER

In order to offer you a plan that best suites your needs, medical aids have a number of options with different benefits and premiums.
And they all offer a hospital (major medical) benefit.

You can then choose from plans that only cover hospitalisation to plans that cover hospital as well as out of hospital cover like doctors and dentists.

If you choose a network plan (you can only use to providers linked to the scheme), then you will get discounted premiums.

Within these plans you also have a choice as to how much providers are paid by the medical aid (scheme-rates or higher), as well as limits on benefits.
The less the premium, the more restrictive the cover.

Ask yourself:

Now it should be easier for you to choose between two basic options:

Types of Medical Aid in South Africa

Hospital plans - ONLY offer in-hospital benefits and emergency service.
You pay out of hospital costs - except the prescribed minimum benefits (PMBs) of which any chronic conditions are covered.
THESE ARE NOT INSURANCE-BASED HOSPITAL PLANS, which are very restrictive in cover!

Traditional option - pre-defined benefits and limits, from expensive, comprehensive plans to limited, more affordable plans.
Benefits are in rands or fixed number of consultations and treatments.

New-generation options - in hospital benefits with a medical savings fund for day-to-day costs.
You can spend the funds as you wish, within certain limits. The full annual amount is credited to your account at the beginning of the year. Any year-end balance is carried over to your next year. Once savings are spent you pay further costs that year, except if you have a plan with a above-threshold benefit. Then, once your claims have added up to a pre-determined amount and your savings are used, the scheme pays further costs that year. Some thresholds are limited.

Network options - you choose to use providers linked to the scheme and get discounted premiums. Networks of hospitals, doctors, pharmacies, optometrists and dentists. This does no mean you receive sub-standard treatments. A good network medical scheme should ensure that it contracts with practitioners who provide quality care, and that its members claims will be paid in full.
Most premiums are related to your income, so those with lower incomes can still join a medical aid.

100% or 200% of scheme rates
At the beginning of the year medical aids meet with providers to determine a basic rate for services. This is known as the medical aid rate or 100% of scheme rates. Private providers can charge up to 5 times this rate.
More expensive plans pay up to 2 times this rate, reducing any potential in-hospital shortfall you may incur.
Some schemes require you to use a listed provider in which case your costs are paid in full.
Many schemes are also introducing co-payments for certain procedures, both in and out of hospital.

It is highly recommended you consider a Top Up plan that will pay for any in-hospital shortfall or scheme-related co-payment.

Look at your budget - what can you comfortably afford to spend each month?

If you can't afford to join a comprehensive scheme then choosing an in-hospital only plan or a network plan will be way better than nothing at all!
Discovery Health's KeyCare plan is the best of these network type plans. It the 3rd largest plan in South Africa. There must be a reason for that!

Whatever you may do, never be without hospital cover!

Remember, the extent of your plan benefits and limits determines the premium you will pay.

CONTACT ME. I have a dedicated team within the medical aid.

There to assist YOU - all the time. And at NO EXTRA CHARGE!
Just send me your application.

medical aidLastly, matching your needs to the plans on offer.



VALUE-ADDED PRODUCTS

Most schemes offer a range of preventative care benefits in order you to remain healthy.
They offer cover for treatments such as flu injections, mammograms and prostate screening, blood pressure and cholesterol tests.
You need to investigate the value of these preventative care benefits, as they may aid in preventing future serious conditions developing.

Other schemes offer lifestyle reward programmes, like Discovery Vitality.
The scheme incentivises you to keep healthy, but it does cost extra and you do need to use the programme in order to get rewards.
Vitality is the leading wellness programme.

The most important action you can take is to use an accredited, knowledgeable healthcare broker like myself

WHICH PLAN TO CHOOSE?

Whilst it is not for me to select your plan, herewith some pointers...Always make sure that you understand the rules of your medical aid for what is not paid is as important as what is paid!
All medical aids exclude certain treatments. Make sure you know what is excluded. Remember, it is a medical aid not a medical aid paid!

Get to know what your medical scheme offers. Read the fine print. It is your responsibility to know what it is you are buying.


choose medical aidGET AN AFFORDABLE MEDICAL AID QUOTE

I will send you some options to consider.

Please use my services.

I am an independent medical aid adviser. I promote many companies and can find a plan to suit your needs.
I am fully licensed and accredited with the Council of Medical Schemes and am in a position to give you comprehensive advice.

Don't leave your concern here. email me for advice - no obligation!
Especially if you are considering How to Choose Medical Aid in South Africa.
The last thing you need is a financial shortfall when you are trying to recover!

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2017