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Your shield against high medical costs.

Medical aid will provide you with immediate funds to pay for unforeseen medical costs. It is invaluable in South Africa today!

Here is a summary of what medical aid can do for you:

Monthly Contributions - Members of a medical aid plan pay a monthly amount, often referred to as a "contribution" or "premium."
These contributions are pooled together to create a fund that will be used to cover various medical expenses.

Access to Quality Treatment - A medical aid plan ensures you get private medical treatments, procedures, surgeries, and hospital care that might otherwise be financially out of reach.

Governed by the Medical Schemes Act - Medical aids operate under the Medical Schemes Act, which ensures meet certain basic requirements. They are not-for-profit companies, so exist for the member's benefit. They are strictly regulated.

Prescribed Minimum Benefits - Unlike medical insurance plans, medical aids must cover Prescribed Minimum Benefit (PMB) conditions.
These benefits are non-negotiable, and ensure comprehensive cover for essential healthcare needs.

Private Healthcare - Medical aid members do not use the poor state facilities and the challenges they present.
They use private providers, guaranteeing prompt and specialised care.

Emergency Hospital Admission - Medical emergencies can happen at any time, to anyone. Medical aid guarantees hospital admission without expensive upfront deposits. Urgent medical care is immediate.

Common Queries About Medical Aid in South Africa

What does medical aid pay for? Hospitalisation, doctor visits, prescribed medications, dental and optical treatments, preventative disease screenings, chronic illness management and much more.

Is medical aid essential for me? In South African having, at least, an in-hospital benefit plan is necessary. With such high healthcare costs, a medical aid provides you with important financial protection, especially for older individuals and those with ongoing health concerns.

Can the unemployed secure medical aid? Yes, provided the premium can be paid. Some schemes offer income-related plans for individuals with lower or no income, offering valuable benefits at an affordable price. Your premium can be paid by another party.

Can I join 2 medical aids at the same time? No, you can only be a member of 1 medical aid at a time. Medical insurance plans are available for additional benefits, focusing on specific treatments like hospitalisation and dentistry.

Adding loved ones to your medical aid - You can add a partner to your medical aid if you are living together - as if married. This may give you a lower premium than 2 single members. You can add close family members, including stepchildren or adopted children.

Can I get pregnancy benefit if I am pregnant when joining? No, most medical aids do not offer pregnancy benefits for a new member who is already pregnant. Pregnancy is often considered a pre-existing condition and may be excluded from benefits.

Can my ex-spouse stay on my medical aid? If a court awards medical benefits to your ex-spouse as part of a divorce settlement, you can keep them on your medical scheme. Additionally, if you get married again, your new spouse can also join your medical scheme. Any children, including stepchildren or adopted children who are your dependants, can also be included in your medical aid.

Can I put my mother, father, grandparents, or siblings on my medical aid? Most medical aid schemes allow you to add close family members to your plan. However, you may need to prove that they are financially dependent on you for their livelihood or provide a court order as guardian.
Eligibility criteria can vary between different schemes.

Can someone use my medical aid? No that is fraud.

Understanding Unlimited Benefits - this means there are no predefined limits on the amount medical aid will pay for specific treatments or services. This allows for unlimited claims (within the rules, limits and benefits), ensuring comprehensive benefits in various medical scenarios.

Co-payments - Even with unlimited benefits, certain costs may remain your responsibility, particularly with expensive procedures. You need to be aware of them. Top-up/Gap plans are highly recommended to help meet these added costs.

Evaluating Risk Factors - Medical aids assess personal and family health history when underwriting applications. While adverse factors don't affect premiums, they may result in waiting periods, so you must be honest with disclosing any health factors you may have.

Choosing the Right Network Plan - Some plans offer guaranteed full in-hospital payment, however they do require you use a network of hospitals and healthcare providers. Use providers outside of the network, you may be liable for extra charges.

Bridging Gaps with Top-Up Plans - Schemes normally pay claims at 100% of medical aid rates, however private providers can charge up to 500% of medical aid rates. A top-up/Gap plan will pay any of these shortfalls for you.

Chronic Illness - A comprehensive plan with good chronic medicines benefits is essential for those with a history of hereditary chronic diseases.

If you have existing or are expecting future health issues – that are NOT PMB conditions - a comprehensive plan may be best for you.

If you are healthy, with minimal day-to-day needs,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 immediate access to the best treatment when you need it and that cannot be under-estimated!

083 655 2164

You must consult the schemes/company product brochures and rules for comprehensive benefit descriptions.

We will offer you the best help at no cost!

Medical aid pays healthcare costs.
What if a disability stops your income?

YOUR TRUSTED, QUALIFIED ADVISOR:
Peter Pyburn - Authorised Financial Services Provider, fully licensed to render financial services since 1991. Death and Disability Planning; Retirement Planning; Investment Planning; Healthcare and Estate Planning.

Council of Medical Schemes

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Last update: January 18, 2025