The Best Advice and Ideas on what to do with your Medical Aid.

What a healthcare adviser does for healthcare.

Do you downgrade or join a hospital plan?

Medical inflation is way above normal consumer inflation and with the effects of the pandemic drastically affecting our incomes, most medical aid members have little option but to investigate alternative healthcare plans and ways to afford healthcare.

If you are considering stopping your medical plan and saving that premium to self-fund your medical cover … THINK AGAIN!!!
The greatest risk we face is not having medical aid today – so do not cancel your plan!

These ideas may help you prevent having to terminate your valuable cover.

And if you are not yet a member – BEST YOU JOIN A PLAN TODAY!


best medical aid adviceThe Covid-19 pandemic has made us realise just how important it is to join of some sort of medical insurance plan – whether that is a simple hospital only or fully comprehensive plan.

Living in South Africa, we have no choice but to have some sort of healthcare as the state medical system is not an option to happily use.

Life-saving treatment in private care will cost far more than your annual medical aid premium! You are not bullet-proof. Don’t think you are never going to face high medical expenses. Accidents or illness can and does happen – to anyone of any age!

Join medical aid NOW. It’s the finest safety net you can get for yourself and your family.

Anyone needing emergency medical attention or admission to hospital – say from a car accident or Covid-19 - who has no medical aid has a HUGE problem! An ambulance will transport you to the closest suitable trauma facility and this needs to be private care. But if you have no medical aid, they will stabilise you then transfer you to a state facility! Not the best situation for anyone!

You may also not be admitted without a substantial cash deposit!
This can be absolutely devastating to your financial circumstances, let alone your health!

If you are unconscious and it has been established that you belong to a medical aid, you will be taken to a private hospital. Just think what will happen if you are not a healthcare member!

Remember that state care still requires payment of fees, depending on what they believe you can afford! You still land up paying for treatment, but in an overcrowded and understaffed hospital with little prospect of getting the care you may desperately need. Again, not ideal!

A simple procedure like the removal of wisdom teeth (with a few hours in hospital) can cost upwards of R13 000!

Private healthcare is very expensive and with no “medical insurance” plan, self-funding private hospitalisation (even for a single operation) will quickly exhaust your savings.


Suffering from COVID-19 greatly increases the risk of complications with co-morbidities, or the coexistence of two or more diseases or disorders you may have – and not know that you do!

Without medical aid, all your medical expenses, especially those at a private facility, will be for your own account. And this at a time where you’re at risk of falling seriously ill.

COVID-19 is classified as a Prescribed Minimum Benefit (PMB), so a medical scheme has to cover costs related to your diagnosis, treatment and care (consultations, medication and hospitalisation).
BUT, if it causes complications to some other condition you have, those costs will be for your account.

A 2-week stay in a general ward can cost around R99 000.
But what if you need ICU care for say, 14 days? That can cost about R392 000!

During the pandemic, large numbers of patients have been avoiding necessary hospital visits, fearing catching the virus. This delayed treatment can only cause medical complications and fatalities, unrelated to COVID-19. And in the future, these patients will have to return to the hospital system, further stressing the healthcare system.

There is an increased risk of you not getting good private care in the future, especially as the number of good specialists and providers in South Africa is rapidly diminishing.
You will pay – and pay a lot – for the best care in the near future!

Premiums always increase way above the rate of inflation. It’s a classic “supply and demand” price!

Joining a medical aid will protect you and your family from having to pay high, unexpected medical costs yourself.
It ensures that you can get the best treatment quickly and that is vital for any recovery!

You should, at least, join an in-Hospital only benefit plan to cover your greatest threat of high medical costs at a very affordable premium.


Terminating your medical aid is the worst decision you can make.
If you are battling to meet the premiums, the best idea is to move to a lower, more affordable plan or “buy-down”.

How to “buy down” a medical aid.

The greatest risk of high medical costs lies with private hospitalisation and dental care, so your plan must have the finest of these 2 benefits!

Medical aids offer 2 main areas of cover: in hospital and day-to-day benefits.

In hospital is normally fully covered by the scheme, although you many have some co-payments with certain procedures.

Day-to day costs are covered by way of a savings fund, as part of your plan. All costs are paid from this fund.
More expensive plans have a safety net that will pay further claims, should your savings be spent.

That said, joining an expensive medial aid plan that has savings for your day-to-day out or out of hospital expenses, may not necessarily equal better benefits!
You may well do better as a member of a hospital only benefit plan and self-pay your day-to-day costs!

We join a medical aid to ensure peace of mind and access to funds for the “big ticket” private healthcare costs. Hospitalisation costs may run into hundreds of thousands or even millions of Rand.
Always make sure that you have sufficient risk (i.e. hospital and related costs) cover in place.

Day-to-day expenses can be managed separately on an as-and-when basis.


hospital plan
Most medical aids offer these plans.
Here we are ONLY talking to medical aid in-hospital benefit plans.
Not hospital plans, as these are insurance products, not bound by the same rules medical schemes have to meet. They pay fixed cash benefits and can be extremely restrictive when claiming - very unlikely to meet more than a small fraction of your actual costs.

Join an in-hospital only medical plan because, claims are determined according to the actual healthcare expenses you face and not on a pre-agreed, daily cash sum which can never accurately protect you from unknown costs!
A far more secure form of healthcare cover!

Please see Is a Hospital Cash Plan (not a medical scheme hospital plan) worth it?

Medical scheme in-hospital only plans cost less because they only pay for costs related to in-hospital treatment, including surgery, ward fees and/or specialist fees.

You pay all your day-to-day costs like GP consultations, physiotherapist, medicines and glasses on an as-and-when basis.
This is not too great a risk, as we have never heard of a member going bankrupt over a chemist bill. But a family spending 2 weeks in intensive care … well, that is another story altogether!

If you are concerned about not having day-to-day savings, there is a plan that offers savings - which you then pay for ONLY WHEN YOU SPEND THEM!

This is the only plan to allow you to control your premium, through the use of your day-to-day savings!


hospital plan benefits

A Hospital only benefit plan covers you from admission to discharge in hospital.

It pays accounts that are related to your treatments like theatre, X-rays, medication, blood tests, blood transfusions, etc.., and these are usually covered in full as hospitals charge what medical aids pay.

However, private providers like doctors and specialists can charge what they like.
And these fees can be up to 5 times what a medical aid pays!

Different medical aid plans will pay at 100%, 200%, or even 300% of these fees – the higher the payment, the higher your premium!

Shortfalls are almost guaranteed to occur with these providers and you should seriously consider a Gap or Top Up plan which will pay any shortfall or procedure co-payment.

If you do have a Gap plan, you can then consider joining a “lower” benefit/ lower premium hospital plan, safe in the knowledge that you will have cover.
In some instances, the “saved” premium of the lower hospital plan will pay the Gap plan contribution!

It is important to note that medical aid hospital only plans offer the same hospital benefits as most comprehensive plans, but without day-to-day benefits.
Premiums are therefore much lower!

Whether you are on a hospital plan, or a more comprehensive medical aid benefit option with savings, your medical scheme should fund your qualifying hospital claims in the same way.


genesis medical aid1. Genesis starting from R 1,340 pm.

Genesis is a scheme that really understands the financial pressure that lock-down has brought to South Africans. They understand the need for reducing medical aid costs and the advantages of joining an affordable hospital plan.

For the ninth consecutive year, they have had the lowest average contribution increase of 4,9%!


Yes, both your highest medical financial risks are met in one, very affordable plan!

In the most recent GTC Healthcare Consulting Medical Aid Survey, the Private Choice hospital plan was rated as one of the best hospital plan benefit options in South Africa!

You have full choice when choosing your hospital, doctor, or medical specialist and have unlimited in-hospital cover.

Hospital accounts, including treatment for PMBs, will usually be paid in full and in private hospitals, the charges of attending doctors/specialists and other healthcare service providers, even for PMBs, will be reimbursed at 100% or 200% of the Scheme Tariff, depending which plan you join.

Genesis is able to boast of a very high claims paying ability putting giving you the security that your claims will be paid. They are very solvent!

If you can self-pay out of hospital costs then this is the scheme you need!

momentum medical aid2. Momentum Health starting from R 1,706 pm

Offering comprehensive, no overall annual limit in-hospital and chronic illness cover on all plans, they give you the option of using any hospital or listed private hospitals.

They also offer discounted premiums depending upon your choice of using listed hospitals or from where you source any chronic medication you may require.
You have a choice of using any doctor or chemist, listed providers or state facilities with the greatest discounted premium (choose this option the plan if you have no chronic needs).

If you able to self-fund day-to-day costs then this next scheme is your answer!

This is the best scheme, because it offers you the finest in-hospital cover and a safety net of money in case you suffer excessive out of hospital costs!

fedhealth medical aid3. Fedhealth starting from R 1,788 pm ...

All Fedhealth plans are essentially unlimited hospital plans, but with the OPTION of using day-to-day savings if you really need them.

And only repaying those savings WHEN YOU SPEND THEM!

This is unique and revolutionary scheme gives you full control over how you use and pay for your medical aid, through giving you full control over your savings.
You only pay for what you use. So, when you do not use the savings, your premium remains lower, as you are not repaying a savings fund “loan”, as with other schemes.

If you do use your savings, the amount you spend is repaid over the next 12-months – interest-free!
One-twelfth of what you spend is added to your next premium and so on, till the “loan” is repaid.

And because these savings are not regulated as part of a medical aid, the amounts are higher than standard medical aid saving accounts!

If you want the same benefits, but in a traditional medical aid savings account, Fedhealth offer the identical plan!

They will administer the plan for you, in the same way as other medical aids operate. There is no added admin for you (but also no opportunity to save premiums either!)

Flexible savings plans from R R 1,788 with R9,600 savings.

Fixed savings plans from R 2,088 with R 3,900 savings.

That’s not all … Fedhealth offer you lower premiums if you choose either of two discounts!

11% if you use listed hospitals (outside of an emergency) and 25% if you accept a R 12,500 fixed excess for planned procedures at a hospital of your choice.

Just look at what Fedhealth offer you...

Only Fedhealth pays for all of these benefits:

  • Unlimited network GP visits once you have reached a pre-determined claim amount!
  • 7-days take home from hospital medicines!
  • Unlimited Specialised radiology (MRI/CT scan) in and out of the hospital!
  • Unlimited 30-days post-hospitalisation treatment!
  • Female contraceptives!
  • You only pay for 3 children!
  • Financially dependant children pay child rates up to age 27!
  • Unlimited Trauma Casualty!
  • Certain post hospitalisation treatments for 30-days!
  • Upgrades any time of the year within 30 days of a life-changing event

2020 asked a lot from you. Now it’s your time to get answers.

Ask yourself “WHY” other medical schemes make you take a more expensive option “just in case”, instead of letting you upgrade if something actually happens?

Then ask yourself why you haven’t switched to Fedhealth yet?

top upPrivate provider fees are not regulated and many can charge up to 500% of the medical scheme rates!

Some plans pay claims at 200% or 300% of medical aid rates, offering you a lower claim shortfall, but these are more expensive.

Increasingly, plans also have procedure co-payments, which you have to fund.

You are strongly advised to consider a GAP or TOP UP insurance plan to address these threats.

This separate insurance plan will cover most in-hospital claim shortfalls and scheme co-payments.

By adding a Top Up plan you can improve your medical aid benefits, so-much-so, that you can even consider joining a lower cost/benefit plan - with a lower premium - and still have an excellent, no risk medical aid for virtually the same premium as the higher medical aid!


Day-to-day (out of hospital) costs is the area where you can most actively control your medical aid premium.

A savings account housed within a medical aid is probably the most expensive way of saving! Although it is your money, you cannot control it, (EXCEPT FOR FEDHEALTH PLANS!) as the medical aid manages it for you.
And they charge administration fees for that!
So, you get less out, than what you pay in!

It is a compulsory loan you must pay – even if you seldom (if at all) use it.

If you don’t use a great deal of day-to-day healthcare, it makes sense to consider insuring for your high-risk costs like hospitalisation and self-pay your day-to-day costs!

Please read 11 Best Ways to Make your Medical Aid Super Affordable.


medical aid savings
Because these monies need to be easily available, you need to consider specific products like:

  • A simple bank savings account, linked to a debit card.
  • Your credit card, but beware as using the bank’s money can be very expensive. You need to be very disciplined and pay any credit off within your statement period.
  • If you only need savings as a safety net for high costs and will not be spending regularly, then consider using an access bond – if you have one. You will pay your bond off early, saving huge interest and have a large pool of funds available for dire needs.
  • Or, best of all a Debit Health Card. This is the finest way to build up funds to be used for basic healthcare costs, even if you have no medical aid!
    The card can only be used to pay medical costs, ensuring that you have funding available.
    You can link other family member’s cards to the account and be safe in knowing those monies are only there to fund medical expenses.

Many members are joining an in-hospital only benefit plan and self-paying their out of hospital costs.

(Obviously, if you have a high need for day-to-day services like GP’s and medicines, this is not an option).

This change will immediately save you considerable premiums!

High premiums or comprehensive medical aid plans do not always ensure better benefits. Yes, some comprehensive plans do have added benefits like extended chronic illness conditions, biological drugs, unlimited cancer cover, etc.

However, if you have limited finances and have a choice of no medical aid at all or a hospital plan, the hospital plan is a “no-brainer!”

It will address your greatest risk and give you the finest peace of mind.


downgrade medical aid
Downgrading your plan in order to reduce your premium can be a risk, especially if you and your family members suffer from ill health, have a family history of illness, or suffer from or may be at risk of a chronic illness.

Beware, a lower benefit plan may leave your family without adequate medical cover, particularly with an unforeseen medical event. You may have to self-fund for a number of incurred expenses.

Your expectations with a lower benefit (lower premium) plan, will have to reduce!

On the other hand, sometimes, upgrading your plan may be a wise move! Although it does cost more, you will have greater peace of mind in uncertain times, knowing that your medical needs will be taken care of - especially when you have a growing or aging family.

Using linked providers.

Unfortunately, freedom of choice always comes at a price. So, all medical aids offer plans that require you to use listed providers from hospitals to specialists doctors and medicines at cheaper premiums.

If you can use these providers, you get:

But, the trade-off is that you cannot choose who treats you.
And that your closest provider may not be convenient for you.

Income-related plans.

These plans offer premiums that are based upon your income level.
They are designed to give low-income earners access to private healthcare.

However, because they have lower premiums, they have a number of restrictions - like, using only linked providers and no specialised dentistry or joint replacement benefits.
Some also require the use of state hospitals, so you need to fully understand how they work.

Please consult an experienced and licenced Healthcare Adviser to ensure you get the very best out of your cover.
We can advise on a plan that suits your needs and budget!

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Last update: May 6, 2021


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