Are you considering stopping your medical plan and saving that premium to self-fund your medical cover?
THINK AGAIN because having no medical cover is a disaster!
Saving your monthly contribution might seem as a good idea, until a family medical emergency or hospital bill puts a BIG dent in your pocket.
A medical emergency can happen at any time – to anyone. A car accident happens within a split second, yet may take months and thousands of rand, for private hospital treatment, to recover from.
Unless you know this will never happen to you and your family, never - ever be without at least a private hospital plan!
Your two risks of high medical costs are with private hospital and dental treatments.
ONLY a medical aid can provide instant money to get you the finest care available!
No healthcare cover means:
Yes, South Africa does have state-run medical facilities, where you are charged according to how much you can afford, but these institutions are typically overcrowded and understaffed, so there’s no guarantee that you’ll get the care you need.
Even if you are prepared to make use of a state hospital, depending on what you earn, you may have to pay, as state hospitals are expected to charge households with an income of more than R72,000 a year.
A basic wisdom teeth removal can cost upwards of R 15,000! The total cost of antenatal care, delivery and postnatal care can range from R60 000!
Taking out a loan to pay back family members who may (or may not) help you financially, is complicated thing to do from a hospital bed! And the cost of borrowing money is huge.
This is a financial NO-NO!
And any potential medical misfortune that may happen to you, will not wait for the NHI to be in place either!
Unless you are going to save a large amount every month and substantially increase it every year, you will never have enough saved to really protect you from high costs. Never!
The sooner you join a plan, the lower the chance of a waiting period.
If you wait until you need a medical aid, the chances are you will not be able to claim because of waiting periods!
Medical schemes must accept any person who wishes to join the scheme (open enrolment). So your application cannot be rejected.
The scheme cannot exclude any condition that was not diagnosed or treated in the 12 months prior to applying to joining.
They must cover 270 life-threatening medical emergencies and 26 chronic conditions, irrespective of the plan you join.
They cannot charge different contributions for the same plan. Only if you have a late penalty or have joined an income-related premium plan can rates differ.
|Medical Aid Hospital Plans are:||Hospital Insurance Plan is:|
|Governed by the Medical Aid Act||Governed by the Short-term Insurance Act|
|Full PMB cover||Nothing|
|Unlimited, high in-hospital sub limits||Low rand amounts per day in hospital|
|Mostly unlimited in-hospital cover, and stated benefits or savings fund for day-to-day costs.||Fixed or stated amounts of money for every day in hospital.|
|In-hospital and comprehensive plans (including day-to-day benefits).|
Hospital accounts usually settled in full and related accounts (doctors and other providers) at scheme tariff.
|In-hospital cover only.|
Cash benefits can range from R200 to R5 000 pd.
Daily benefit is constant and not linked to the actual cost of treatment or medical bills.
|Any private or listed network hospital.||The daily benefit remains the same, whether a private or public hospital is used.|
|Accepted by private hospitals, so no deposit required||Only emergency accidents | Guarantee of payment needed before admission|
|3 and/or 12 months waiting periods, no pre-existing condition may be permanently excluded.|
Start immediately where no waiting periods stated.
|Most plans cover accidental hospitalisation from start of the policy.|
Illness can be after either 6 or 12 months.
Can totally exclude conditions
Waiting period of a number of days spent in hospital – usually after 2 days.
Pre-existing medical conditions permanently excluded.
|Yes for PMB's||No to PMB's|
|Comprehensive major medical cover||Rand amount or number of annual events|
|Comprehensive dread disease cover||Rand amount or number of annual events|
|27 Chronic conditions covered||Nothing|
|Payment usually directly to the hospital and providers.||Payment directly to the member, who must settle accounts.|
|Hospital cover usually unlimited.||Hospital cover usually for a fixed limit, which may not be sufficient for extended hospitalisation.|
|Open enrolment with no age limitation.||Limited ages.|
|Medical schemes are non-profit organisations.||Short-term insurers are for-profit companies.|
Please note that not all aspects have been covered above and the information provided is neither a complete report/analysis nor is it intended to flout or in any other way compromise the conditions set out in the Financial Advisory and Intermediary Services Act’s General Code of Conduct insofar as comparing different financial products with each other is concerned.
If you cannot afford a comprehensive medical plan, then you MUST AT LEAST HAVE THIS PLAN because it offers you cover for:
Add a Top Up/Gap plan to it for around R 387 pm.
Now you will have the finest cover paying up to 5 times medical scheme rates in hospital!
At the lowest cost we know of!
Take the difference in premium that you would have been paying (or any amount you feel comfortable saving) and save that yourself in a bank savings,
until you have an amount - say equal what you spent out of hospital last year - that you feel is enough.
Invest into a unit trust after that. You’ll have an investment you can use for future dreams and goals – again that you can get to at any time.
Go even better…save the money into your access type bond…if you have one. Now you are cooking! The power of compound interest really works for you if you pay more off against your home loan than you have to.
That’s serious savings over the longer term!
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.
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!
TALK TO ME .... I am here to help you - AT NO CHARGE!
Send me your questions and concerns. I'll answer them for you.
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You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.
Medical aid pays healthcare costs.
What if a disability STOPS your income?
Last update: May 6, 2021
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Medical Aid Authority Peter Pyburn.
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