Questions About Medical Aid in South Africa.

Easy to understand answers for all your concerns.

Best Medical Aid in South Africa

Medical Aid Questions. The answers are not as complicated as you think!

1. Why do I need a Medical Aid?

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

3. Why must I join a Medical Scheme NOW?

4. How do I join a medical aid?

5. Tips on Medical Aid.

6. What to consider when taking out a hospital plan.

7. Do you need help understanding your medical scheme benefits and limits?

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

9. Medical Aid Terms and Definitions

Why do I need a Medical Aid?

Good health - and the ability to quickly recover from ill-health - is the most important aspect of a successful life!
All too often, it is only when we are in an emergency room, that the true value of a medical aid becomes apparent!
That is when having a good medical aid removes a great deal of stress.

Being able to afford the best care - as fast as possible - is vital.

9 compelling reasons for joining a medical scheme in South Africa!

what does medical aid doWhat does Medical Aid do and why is it important to me?

A medical scheme helps you to pay for your healthcare needs, such as nursing, surgery, dental work, medicine and hospital accommodation.

Unless you have large amounts of money available (at very short notice) you will be unable to get the best medical assistance in an emergency.

You will not be able to access private care and that can have severe healthcare consequences for you and your family!

why join medical aid nowWhy must I join a Medical Scheme NOW?

You can have a car accident the next time you travel!
Or 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?
And what if you have an emergency? Can you fund that cost - immediately?
If not, then you seriously need to consider joining a medical aid NOW!

Medical aid is seen as a grudge purchase - something that is expensive (and a waste of time if you claim little from it), but the longer you delay joining, the more expensive it becomes.

The basic design behind medical aid is one of risk-pooling - where a healthy member helps subsidise the expenses of the unfortunate, more sickly member. However, people have a dangerous attitude of "Why must I join when I am not going to need it?"

No one can predict what expensive health issues they may have later today! Emergency hospitalisation is not cheap! Then as you age, you are going to experience a higher need for medical services. That can be financially crippling without a medical aid to help pay costs.

So, the Medical Schemes Act protects the schemes, by allowing waiting periods and late-joiner penalties to be levied on new members who join later in life - only when they need help.

You can land up paying up to 75% per month more!

When you apply to join a medical plan, you complete an application. That is then underwritten by the scheme.

That scheme then can add Waiting Periods, the length of which depend 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 years of past medical membership you have.

So, the sooner you join a medical scheme, the faster any potential waiting period can begin. And the lower lower any possible late penalty will be.

To find a medical scheme with no waiting period is very unlikely.

You can never be too young or too healthy to join a scheme!

join medical aidHow do I join a medical aid?

Joining a Medical scheme may seem to be a very complicated procedure!
But, it really is not!

All it needs is a little planning and some guidance ... and that is what we offer you.

How to join a medical aid.

Yes, we offer help - at NO CHARGE!Make joining a plan simple and easy.

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?

Tips when considering a Medical Aid

  1. Join a good plan before any serious illness strikes.

    Look ahead 5-years to try and 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 Schemes only allow plan upgrades at year-end - EXCEPT FOR ONE!

    If you suffer a life-changing event (from pregnancy to cancer) you can IMMEDIATELY upgrade your plan.
    Now you can join a cheaper plan, safe in the knowledge that, if you need better benefits for such events, you can get them!

  2. Don't choose a plan purely on cost!

    Identify what benefits 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!

    Remember, pay cheap premiums and the chances are you are joining an unsustainable plan with equally cheap benefits!
    You could land up in hospital, facing huge costs that your plan does not pay!

    When it comes to choosing an affordable medical aid, we try to make this easy, simple and as quick as possible for you. USE US!

    You run a real risk when “cutting out the middleman!” Especially when it costs you nothing extra!

  3. What about exclusions, limits and implications of a scheme’s network of doctors?

    A medical aid may exclude you from a specified condition for a period of no longer than 12 months. This is also known as a condition-specific waiting period.

    However, if you are not honest when you apply to join a plan - by disclosing your full medical information - that scheme can repudiate your claim and not pay it, or worse, terminate your membership, permanently exclude you from ever joining them again and take legal action against you.

    If your plan does not cover a medical procedure or service, (as stated in the plan rules), then you cannot claim for it. This is especially so with lower cost/lower benefit plans.

    If you join a network plan - where you use linked providers - and you use a service outside of those networks, you will be liable for a co-payment for any amounts charged in excess of what the plan pays.
    They may also not pay anything at all!

    This makes it vital that you have read and understand your plan rules.

    We will provide the information you need if you use our services – 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 and we will respond far more quickly than getting a broker appointment!

  4. Avoid Hospital Cash Plans

    They 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.

    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.

    A far more secure form of healthcare cover!

  5. What about wellness and loyalty programmes?

    These should not be the reason you are buying a medical aid!
    It costs money to belong and accumulate benefits with these programmes!

    A free rewards programme is worth what you pay for it!

    However, some wellness plans are worth it and if you are dedicated enough to use them properly, you can get rewards.

    The biggest return is the incentive to get and keep healthy. That alone is priceless!

    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.

quote I want a quote

join medical aidWhat to consider when joining a hospital only benefit plan.

Because a full medical aid is so expensive, many members are looking for alternative forms of cover.
And the best place to start, is to address your 2 greatest medical financial threats ... private hospitalisation and dental costs.

You can choose to join either a medical aid hospital only plan or an insurance-based plan.

The Difference Between A Medical Aid Hospital Plan and Hospital Cash Insurance.

Medical Aid Hospital Plan.
Hospital Insurance Plan.
Governed by the Medical Schemes Act
Governed by the Short-term Insurance Act
Full PMB cover
Unlimited (or high annual limits)
Low overall annual limit and sub-limits
High in-hospital sub limits
Low rand amounts per day in hospital
Maximum 12-month waiting period
Can totally exclude conditions | Individual product waiting periods.
No maximum entry age
Has maximum entry ages
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
Accepted by private hospitals, so no deposit required
Only emergency accidents | Guarantee of payment needed before admission

Medical Aid Hospital Plans cover your emergency or planned expenses in hospital.
Costs like:

They are perfect for the healthy or younger member who has little need (and can self-fund) out of hospital benefits.

There is a hospital plan that includes essential dentistry and surgical procedures done in a GP room!
From as little as R 1,255 per month!

Hospital Cash Insurance plans are not medical aids.
They pay cash benefits according to the policy schedule, normally a set amount and after waiting periods which totally exclude claims for short hospitalisation stays.

This payment may not cover your expenses, leaving you with a shortfall.
Gap/Top up plans do not work with hospital insurance, so you will have to pay.

New regulations state that pay-outs are limited to R3 000 daily, up to a maximum of R20 000 per insured life, a year, per hospital stay.
Seriously! A caesarean birth costs around R30 000 and far more if complications occur!

The money is paid to the policy owner, not the medical provider and that is why hospitals will demand deposits on admission.

Because they are low cost, many people choose these plans over a medical aid hospital plan.

BUT, the limited daily amounts they pay are way below the medical expenses incurred while in private hospital!

Hospital insurance companies are ‘for profit’ unlike medical schemes, who are ‘not for profit’. So any profit made is kept by them NOT put back into company to reduce costs.

That is why we do not recommend them at all.

They would be ideal for low income earners (who cannot afford a medical aid or hospital plan) or when used along with medical aid/hospital plan as an income replacement - due to being hospitalised.

Do you need help understanding your medical scheme benefits and limits?


25+ years in medical aid .... we know how it works!!

top upTop Up/Gap Cover - what you need to know:

Medical schemes pay in-hospital costs at different rates and if you use private providers, you could have a claim shortfall.

Schemes are increasingly adding procedure co-payments as well.

What can you do to address this threat?

If you can use providers who 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.

Every medical scheme 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 scheme and will work with any medical aid.

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Last update June 29, 2020

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