1. Why do I need a Medical Aid?
2. What Does Medical Aid Do and why is it important?
3. What is Medical Aid and how does it work in South Africa?
4. 4 Types of Medical Aid in South Africa.
5. Why must I join a Medical Scheme NOW?
6. How to Choose the Right Plan that comfortably suits your needs and pocket.
7. How do I join a medical aid?
8. Tips.
9. What to consider when taking out a hospital plan.
10. The Top 11 ways to Reduce your Medical Aid Premium!
11. Do you need help understanding your medical aid benefits and limits?
12. Top Up/Gap Cover - what you need to know.

1. Why do I need a Medical Aid?

Poor public healthcare is the main reason you need reliable and affordable helpmedical pills with medical costs. Government hospitals are not an option for healthcare treatment. But, private healthcare is expensive. Receiving care in a private hospital if you’re ill or in an accident can end up costing thousands or even hundreds of thousands of Rands.
To get that care, it is necessary that you have a medical plan.
Private hospitals provide higher standards of care and equipment for advanced diagnostic and other technologies. Nursing and medical professionals are generally better qualified and command higher salaries. This results in high costs for hospitalisation or care for serious injuries, surgery, or chronic illnesses. Cost you must meet!
It costs over R 8,500 per night for a premature baby's neonatal stay (and some stay for 5 months) - bed only - no consultations, medicine or medical supplies!

A medical aid gives you the ability to choose a convenient hospital, when you need one. You have NO CHOICE in a government hospital and often they are far from home and an inconvenience for you and your family.

Government ambulance services are slow compared to private services and a good medical aid will get you to a hospital quickly.
If you have an accident or illness in a remote area, a private service will get you to a hospital quickly even if you are in some distance away from an ambulance service.

A medical scheme will protect you and your family financially, should you suddenly have to pay for high medical costs. You do not know what your health may like be tomorrow!
It will also prevent you having experience long delays in your medical treatment. Time that can be life saving.

If you are diagnosed with an illness or condition (and pregnancy is a condition!) a medical aid will place a waiting period on treatment for that condition. So the sooner you join - the better!

With a good medical aid you will have a choice of convenient hospitals if you have to be admitted. Many times, with government hospitals, you have to go where there is space available.
This could be far from home and an inconvenience for you and your loved ones.

Without medical aid – or at the very least a hospital only plan - you will be in serious trouble!
Medical cover is the most important safety net you can buy for yourself and your family.
The importance of belonging to a medical aid cannot be undersetimated! Joining a medical plan must be your priority!

You insure your car, house and aother personal things - DON'T IGNORE YOUR HEALTH COSTS! They can be way more expensive than a damaged vehicle!

2. What Does Medical Aid Do and why is it important?

A medical scheme helps you to pay for your healthcare needs, such as nursing, surgery, dental work, medicine and hospital accommodation. In return for paying a monthly amount – called a contribution – medical aid covers you financially for various medical expenses. Depending on the medical aid plan you’re on, these can include in-hospital treatment as well as things like screenings for certain diseases, day-to-day expenses like medication or GP visits, and dental treatment. Medical aid schemes usually require that you use their own network of hospitals and healthcare providers to be fully covered: if you use providers outside of the network, you may be liable for extra charges.You pay a monthly premium in order to have medical cover. If you have a history of hereditary chronic disease in your family - like high blood pressure, cholesterol or diabetes - you must consider a comprehensive plan with good chronic medicines benefits!
If you have existing or are expecting future health issues – that are NOT PMB conditions - then agin, a comprehensive plan may be best for you.

If you are healthy then consider a hospital only plan and pay your own day-to-day costs.
They are more affordable, whilst protecting you against the real threat of not having a medical aid - hospitalisation!
Some even pay out of hospital dental costs along with Private hospitalisation!

Medical aid is an insurance that covers you for large and unexpected events which could financially ruin you.
It allows you to access the best treatment when you do need it and that cannot be under estimated!

south african medical

3. What is Medical Aid and how does it work in South Africa?

The payments, or premiums, that members of medical aid schemes pay each month are pooled and it's from this collective pot that claims for medical expenses are paid out.

There are 2 forms of medical cover: Comprehensive medical scheme cover that pays hospital and day-to-day and chronic medicine costs, or Hospital plan that will pay in-hospital expenses and chronic medicines only. You pay all out of hospital expenses like GP, dentist, chemist and optical yourself.

Your medical scheme pays claims out of either: the scheme itself - risk cover – usually for major events. This is the insurance portion of the scheme or day-to-day savings – for doctor’s visits, blood tests and medication. When these are spent, you no longer have cover for day-to-day expenses, except on the higher plans which offer a safety net when savings are used.

What a medical scheme pays for from risk versus savings is an important issue.
Some schemes extend the cover that is paid from risk and not your day-to-day savings, thus extending the life of your savings!
For example, emergency room trauma like a broken leg or stitches, are paid, without using your day-to-day savings account.
Some medical aids have extended this trauma benefit further, where ongoing physiotherapy is paid.
They also pay for MRIs and pregnancy scans from the scheme and not your savings!
SOME PAY DENTAL COSTS, WITHOUT USING YOUR SAVINGS, extending the buying power of your money!

There is a medical aid that offers a unique day-to-day savings option, where you only start paying for savings once you use them! Most schemes charge you for savings from the start - whether you use them or not!

Why not provide your own day-to-day savings a bank savings account, or use your home as an access bond – pay extra into it and use that for day-to-day expenses.
We also sell a HealthCard – a dedicated debit card that can only be used for your medical expenses. An ideal way to fund for your day-to-day expenses.

Chronic medicines have to be paid for 26 PMB chronic conditions.
All plans have lists of medicines they provide. If you have chronic need, outside of these PMB conditions, you may need to look at a plan with higher chronic benefits.
We can help you with these concerns.

Most medical schemes have specific benefit programmes for oncology, dialysis and HIV. It is important to make sure exactly what that cover is.

Preventative care benefits. Medical schemes offer a range of preventative care benefits in order for you to remain healthy. Beeits such as ‘flu injections, mammograms and prostate screenings, all paid for by the scheme.
You use network providers, but can get a range of benefits such as GP, dental and screening benefits paid.
Investigate the value of the preventative care benefits, as these will aid in preventing more serious conditions developing in years to come.

4. Types of Medical Aid in South Africa

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

2. 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.

3. 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 with plans that have an 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. Some plans require a co-payment as well.

4. 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 belong to a medical plan. Ideal, affordable plan for pensioners and families on a strict budget!

Here is another good, low cost Network plan, with an option to use any hospital you wish!

5. Why must I join a Medical Scheme NOW?

medical aidYou can have a car accident the next time you travel! You can suffer a survivable heart attack whilst reading this!
How much do you think 6-weeks in intensive care will cost?
Do you have that money to spend?When joining any open medical scheme in South Africa, the medical scheme has the right (in reference to the Medical Schemes Act of South Africa No. 131 of 1998) to implement underwriting on any member joining that scheme. To find a medical aid with no waiting period is very unlikely.

Waiting periods can be imposed on a new members, the length of which depends upon your health and how long you’ve been without medical aid cover.
They can range from a 3-month general waiting period to a 12-month condition-specific waiting period.

There are also Monthly Late Joiner Penalties to consider. The older you are when joining a medical scheme, the more severe the late joiner penalty. The penalty depends on how many past years of medical aid membership you have.

So, the sooner you join a medical scheme, the lower any possible penalty will be. You can never be too young or too healthy to join a scheme!

6. How to Choose the Right Plan that comfortably suits your needs and pocket.

Which medical aid should you join? What can you afford to spend?
If you pay over R10,000 per month and you can have a medical aid that pays everything! But for most of us that is impossible so, you need to know what you can comfortably spend on your plan.

What cover do you need?
The greater your benefits - the higher the premium! So it is vital you have an idea of what you want from a medical plan. If you are happy to get a plan that does not have all the "bells and whistles" (say a hospital only plan), you can save considerable money!

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. But, 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. Schemes also now offer the use of listed providers, in which case your costs are paid in full.
However, there is always a threat of a shortfall with claims. And many schemes are also introducing co-payments for certain in hospital procedures.
You are strongly advised to consider a GAP or TOP UP insurance plan to address this threat.

Young and healthy, you may have little need for doctor visits and medicines.
BUT, we live in a violent country and you do need cover for emergencies and trauma and maternity. You do not want to rely on your family to pay medical costs!
You are laying the foundation for your future health, so ensure you get preventative care benefits with your plan.

With children, you need a more comprehensive plan - hospital, GP, chemist, dentist and optical benefits. But, these are expensive plans, so consider a cheaper option that uses network providers. Prevention is better than cure, so you need regular dental, cholesterol, glucose and blood pressure tests.
Pregnancy is expensive! Your plan must cover you throughout pregnancy and birth. Consider a more comprehensive option before you plan to start a family. Medical schemes will not cover pregnancy if you have already conceived.

You have the need for more comprehensive benefits. Heart disease, cancer, osteoporosis and dread diseases develop during these years, so you need a plan which pays for chronic medication.

How to Choose the Best plan.

Some question you should answer.....

  • What did you spend on day-to-day healthcare costs during the past 12-months?
  • Where did you spend that money? GP visits – Hospital – Dentistry - Medication?
  • Which costs will not happen again (like childbirth)? Which are likely happen again (like flu)?
  • Are you healthy? If you seldom visit a GP , dentist or chemist - then consider an in-hospital only plan? OR if you use a GP, dentist or chemist frequently - maybe a comprehensive plan is better?
  • If you run out of savings during the year, then you need a plan with much higher savings.
  • Do you need chronic medicines? A comprehensive plan may be better? Look for a cheaper plan and pay for some items that plan does not cover?
  • Can you pay doctor, chemist and dentist visits yourself? If yes, choose a medical plan that only covers in-hospital requirements. If not, then choose a plan that pays for day-to-day costs.
  • Will you use network providers? If so, you can get a discounted premium!
  • You may feel you don't need medical aid but, to not have - at least hospital cover - is like driving a car with no spare tyre. A high risk!
    A 20 year old who hasn’t seen a doctor since birth needs something quite different from the 50 year old with high blood pressure and diabetes!


    7. How do I join a medical aid?

    These are complicated products. They used words that we do not understand. Make your life simple and get hold of us.
    We will email you the application with instructions on completing it. Return it to us and we will check and send it to a dedicated team we have within the medical scheme. We will track it and assist with problems all the way through to getting your certificate. FOR FREE!
    You pay what you would going direct as, the medical aid pay us our fee!

    You may think that you’ll never need medical cover, but considering that one episode in a private hospital can set you back hundreds of thousands of rand, is it not better to pay a small monthly contribution to ensure you are covered?

    8. Tips

  • Join a good plan before any serious illness strikes. - Look ahead 5-years to try assess what cover you’re likely to need, track your health history and consider any genetic factors that may play a role.
    Ask me for independent advice to help you choose the right medical scheme package.

    Medical Aids only allow plan upgrades at year-end - ALL EXCEPT ONE! If you suffer a life-changing event (from pregnancy to cancer) you can IMMEDIATELY upgrade your plan.
    So you can choose a cheaper plan, safe in the knowledge that, if you need better benefits, you can get them!

  • Should the scheme be financially stable? - Check their claims paying ability and solvency level.
    Remember, the more members - the better the scheme! So choose from larger medical aids. We only offer plans from the top 5 schemes.

  • Choose a plan purely on cost? - Identify what it is you need, then look for plans that best meet those needs. Be realistic about the state of your health and don’t bank on the invincibility of youth, or your current state of good health lasting forever.

    Compare costs and trim your plan to your budget. You must get quotes before joining a scheme and this is not always an easy or understandable process!
    We try to make this as easy and simple as possible. USE US!
    I do not charge and additional fee! You pay the same as if going direct, but I have years of experience in this field. You run a real risk “cutting out the middleman!” Especially where it costs you nothing extra!

  • What about exclusions, limits and implications of a scheme’s network of doctors? - We provide the information – all you need to do is READ IT!
    It is in writing, so there is no misunderstanding. And you can see that discussion ….anytime!
    We are just an email away. We will respond far more quickly than getting a broker appointment.

  • Why Avoid Hospital Cash Plans? - They are insurance products, not bound by the same rules medical aid 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. Get 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. Far more secure.

  • What about wellness and loyalty programmes? -They are not the reason you are buying a medical aid and you pay to belong to the programme. To get reasonable rewards costs money. A free rewards programme is worth what you pay for it! However, some wellness plans are worth it, if you are dedicated enough to use them properly. Again, talk to me for help in making a decision.

    If you do your research properly and get professional help, you can choose a plan to best suit your needs. Then you won’t be disappointed when claiming, because your expectations will be met.

  • 9. What to consider when taking out a hospital plan.

    Make sure it covers casualty, any admission and certain legislated chronic conditions.
    You also need annual screening and diagnostic tests, procedures and specific vaccines out of hospital (Mammograms, cholesterol tests, prostate tests, flu vaccinations and immunisations for babies and toddlers). Ensure you have professional and extreme sports cover, if you lead an active lifestyle.

    If you want some out of hospital benefits, the Smart plan offers unlimited, network hospitalisation and a co-payment should you need a network doctor, medicine, dental and optical treatments. The best of both worlds!

    What to consider when taking out comprehensive cover.

    A tooth filling, can set you back by up to R8 000, so it may be worth investing in a more comprehensive plan? These plans offer unlimited in-hosptal cover and a savings account from which you pay all out of hospital costs. It is vital you have a reasonable enough savings amount for the year. More expensive plans have a safety net, should you run out of savings.

    What to consider when taking out a network plan.

    Most network plans have income-related premiums. The less your income - the less your contribution and can be a lot cheaper than a comprehensive plan. Network plans offer mostly unlimited hospital, day-to-day and chronic benefits through a network of providers. They cover PMB conditions as well. There is a trade off in terms of your choice of hospital or doctor, but you pay lower premiums.

    The Top 11 ways to Reduce your Medical Aid Premium!

    Are you, like so manmedical aidy medical aid members, struggling to meet the cost of your medical aid plan? Maybe you feel you can't afford to keep your medical aid?
    They are so expensive that we need to consider ways to reduce this cost. However, this is not a decision you can easily make!

    There are so many schemes and plans option available, so much technical wording and a lot of confusing information available,

    Here are some ideas to consider that may help you keep your medical aid:

    Your biggest financial risk is the cost of private hospitalisation. You cannot compromise on this!
    Next highest expense is normally in and out of hospital dentistry. Again effective cover is a must!
    Lastly doctor, chemist and glasses, which you may be able to self-fund through your own savings plan.

    Your answer is to consider joining a lower benefit and cheaper plan.The greater the benefits of a plan, the higher the costs.
    So, consider cheaper options that have smaller medical savings plan or no savings plan at all.

    Whatever you may do, never be without hospital cover!

    1. Hospital Only plan. No day-to-day savings.

    The greatest medical expense threats are in private hospital and dentistry. Visits to the GP, opticial and chemist can be controlled and are very unlikely to bankrupt you!
    BUT hospital and dental costs can be huge!

    All medical schemes offer plans that cover in-hospital costs only.

    There is a plan that offers unlimited in-hospital cover AND cover for certain out-of-hospital dental benefits!
    This plan addresses both the major cost threats we face – all in one plan. It is unbeatable!

    Please see: The Best, Affordable Hospital Plan with Dental benefits!

    2. Hospital cover with smaller day-to-day savings.

    The savings account within a medical aid is simply a fund of your money, saved from an added amount on your contribution.
    If you can reduce the fund you feel you need - you reduce your premium!
    And medical schemes have a few plans with different savings contributions to investigate. One scheme even allows you to design the savings you want!

    You may also be on a plan that offers a safety net, should you use up your savings. These plans are very expensive and here you need to investigate carefully to see if you really are using that threshold benefit.
    It may well be that the cost of that benefit is higher than the actual costs it covers and it would be cheaper to pay those costs (after your savings are used) yourself?

    Coupled with your Top Up plan, you could look at a plan that pays in-hospital costs at medical aid rates and has a small savings.
    At least you have cover for those unexpected costs, whilst managing your normal day-to-day costs yourself.

    Please see: Unique value-added Medical Aid

    4. How about a plan with hospital cover and a small co-payment for day-to-day needs?

    You have unlimited in network hospital cover and network GP consultations, acute and over-the-counter medicine, eye and dental check-ups and sports-related injuries with a co-payment when you access these benefits. So, you only pay for certain out of hospital costs when you need them, not as part of a monthly contribution! If you are young and healthy, this may be an ideqal plan for you?

    Please see: The Smart plan

    5. No savings.

    Your create own savings plan in a bank account or with a medical debit card. Even adding extra to your bond – if you have an access bond facility – is a good alternative!
    In this way you reduce the interest on your bond, which will far outweigh any return you get with a medical aid savings account! And you have access to a large savings fund!
    However, don’t forget that medical schemes do offer you credit in the form of advances on your annual savings fund, if need be.

    Of all day-to-day costs, dentistry is generally the most expensive. So if you are expecting dental treatments, be sure you save a sufficient amount each month.
    OR look to the only scheme we know that pays dental benefits as well!

    Please see: The Best, Affordable Hospital Plan with Dental benefits!

    6. Lower rates depending upon where you source chronic medicines.

    There is a medical scheme that offers lower rates depending upon where you source chronic medicines. Premiums differ if you get your medicine from any chemist, a network supplier or the state.

    Please see: Momentum Health Medical Aid

    7. Move to a network plan.

    nurseWhere a scheme is able to control provider costs - through linking them in a network - the premiums are cheaper.
    Most medical schemes offer network provider plans and you really only need to make sure you can use these providers in their networks. If you are happy to use their networks of private hospitals and day-to-day providers, you can save money!
    There are also network plans that are linked to your income. These are the lowest cost medical aid plans available. However, they can be restrictive in the benefits they offer.

    Please see: INGWE Medical Aid


    If your child is a full time student, there are plans specifically designed for students. They offer excellent benefits for a really good price! Moving them onto their own plan, which you can pay for, is first prize in reducing your overall premium.

    Please see: The Best, Affordable Student Medical Aid

    9. Children older than 21 years of age.

    Some medical aids offer cover – at child rates - for children to age 27, as long as they are unmarried and not earning more than the maximum social pension.

    Please see: Fedhealth Medical Aid

    10. Children working with small incomes.

    And if they are earning a small income, look at the income-related network options. Good benefits for very reasonable premiums.

    Please see: INGWE Medical Aid

    11. Your Parents as Dependents.

    You may also have elderly parents on your medical aid. Again, it would be more than worth your while to investigate moving them to an income-related network plan. This could have a significant overall premium saving for your family.

    Please see: KeyCare Medical Aid

    So you can see there are a number of ideas to help you control your medical aid premium. But the best advice is talk to a broker.
    Let us investigate and present the various options open to you.

    11. Do you need help understanding your medical aid benefits and limits?

    Or with one you are considering joining?

  • Are you wanting to compare your current benefits with another medical aid?
  • Do you have endless problems with the administration of your plan?
  • Are you so frustrated with call centers - who promise everything, but do nothing?
  • Are you still waiting for someone to call you back?
  • Have you problems with unpaid or short-paid claims stuck in the system?
  • Well, I have an answer for you that will cost you NOTHING AT ALL!

    Medical aids pay us for helping you. You will pay the same premiums if you use a broker or not.
    So, it makes sense then to get advice and help from me and my team who fully understand medical schemes.
    We have a dedicated team within the medical aids and we promote the best medical aids in South Africa:

  • Discovery Health
  • Fedhealth
  • Momentum
  • Genesis
  • Compcare
  • Medshield

    Appoint us as your medical aid broker at no extra cost and you can use both us and the team to get your concerns sorted!
    Please complete and return the MEDICAL APPOINTMENT form to us.
    Once appointed, we will be able to investigate your concerns and help you get them fixed.


  • top up

    12. Top Up/Gap Cover - what you need to know:

    Medical schemes pay in hospital costs at differing rates. At the beginning of a year all medical providers and medical schemes decide on the cost of a procedure.
    That is known as the scheme (medical aid) rate.
    Medical aids then start paying at 100%, 200% or 300% of that rate. (Generally hospital and ward fees are charged at the scheme rate and are fully covered.)

    If you use private providers, they can charge what they want - known as the private rate. This can be up to 500% or 5 times more expensive than the medical aid rate!
    To help you meet these high costs medical aids now offer plans, that will pay up to 3 times their scheme rate, but these are still not good enough!
    In addition, they are increasingly adding co-payments for certain in hospital procedures. More expensive plans have fewer co-payments.

    What can you do to address this threat?
    If you can use providers who are have a payment agreement with a medical scheme, they will charge what the plan pays. So, you should never experience an in-hospital claim shortfall.

    Or, best of all, buy a Top Up/Gap plan that will pay any in hospital shortfall and co-payment.

    gap coverIf you have a Top Up plan, YOU CAN CONSIDER A LOWER COST IN MEDICAL PLAN THAT PAYS AT SCHEME RATES, because you are safe in the knowledge you are protected against high hospital costs! Yes, your Top Up will make good on any shortfalls or co-payments you have.
    Every medical ascheme member should have an insurance-based Top up plan. It is a vital part of having full in-hospital cover!
    These are totally separate products to a medical aid and will work with any medical aid.

    Please see: The Best Gap/Top Up plan!

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