Medical Aid Questions. Answers to all your concerns

1. Why do I need a Healthcare plan?
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. Why must I join a Medical Scheme NOW?
5. How do I join a medical aid?
6. Tips on Medical Aid.
7. What to consider when taking out a hospital plan.
8. Do you need help understanding your medical scheme benefits and limits?
9. Top Up/Gap Cover - what you need to know.

1. Why do I need a Healthcare plan?

Good health - and the ability to quickly recover from ill-health - is the most important aspect of a successful life!
And in South Africa, private healthcare is a non-negotiable benefit when having to seek medical help.

In simple terms, we have medical aid to ensure that we are able to pay for the best treatment received from either a GP, specialist or while in-hospital.

We are all too aware of the horrific cost of medical treatment in this country and it is not getting any cheaper!
While the cost of living in South Africa continues to rise, so do medical bills - but at a faster rate!

It is therefore vital that you “insure” your health, after all, that is what a medical scheme does.

Accidents and illnesses are unpredictable and you cannot plan for them. You have to have a way of accessing immediate funds when they strike.

Here are some compelling reasons for joining a medical scheme in South Africa!

south african medical

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 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.

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!

south african medical

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

As a South African you may be only too aware that the cost of private medical care is unaffordable to everyone but the super-rich!
The problem is that we live in a violent and stressful society, so the risk of an accident or illness happening to you is high!

In order to get fast access to the best medical care, you DO NEED TO JOIN A MEDICAL SCHEME and before you look at a scheme's benefits and cost, you should understand what lies behind medical aid.

But, just what is a Medical Aid?
How does it Actually Work?

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4. Why must I join a Medical Scheme NOW?

You 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 (with reference to the Medical Schemes Act ) to implement underwriting on any member joining that scheme.
To find a medical scheme with no waiting period is very unlikely.

Waiting periods can be imposed on 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 scheme 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!

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5. 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 a quote, showing you the cost of various plans. Once you choose one, 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.

ALL FOR FREE! You pay what you would going direct because, the medical scheme pay us our fee!
There is no added 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?

6. Tips on Medical Aid

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.

hospital plan

7. 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 copayment should you need a network doctor, medicine, dental and optical treatments.
The best of both worlds!

If you can afford to save for your out of hospital costs yourself, then an in-hospital only plan is your answer.

And there is one that will even pay dental benefits!

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

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

top up

9. 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 schemes 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 schemes 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 copayments for certain in-hospital procedures. More expensive plans have fewer copayments.

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 copayment.

gap coverIf you have a Top Up plan, you can consider a lower cost in medical plan (with lower premiums) 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 copayments you have.

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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