In return for paying a monthly amount – called a contribution – medical aid covers you financially for various medical expenses. Depending on the medical scheme 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 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. This is the where the scheme pays claims at medical aid rates (100%) and providers can charge up to 500%.
A Top Up/Gap plan will pay any of these shortfalls for you.
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 again, 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!
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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