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Different products from the Medical aid schemes in South Africa |
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South African Financial Services – Insurance – Medical Aid – Different products
Types of Products
A. Traditional Medical Scheme
These are set benefit plans which have limits according to each claim that may be made. Please note the following with regards to claims:
- Limits start a fresh each year
- What you don’t use, you lose
Most joiners would now opt for a new generation type of plan.
B. New Generation Medical Schemes
New Generation Medical Schemes can have two elements within them. All have a risk pool (as described below) and for higher levels of cover (such as day to day cover) an additional medical savings account is utilized.
1. Risk Pool – This covers uncontrollable expenses or major claims e.g.: major surgery.
These can be typical low frequency events but high cost items that you really have no control over.
2. Medical Savings Accounts - cover controllable expenses.
Day-to day expenses like Primary care and visits to the GP, over-counter medication is normally paid out of the savings account.
More about Medical Savings Accounts
- Savings account cannot exceed more than 25% of the annual contributions.
E.g.: 25% = a total of 3 months of annual contribution.
- Some schemes give members the option of 10%, 15% or 25% of the annual premium for their medical saving account.
- Money in a savings account can be carried over, if not used, to the next year and added to the New Year’s savings.
- Upon termination of membership with one scheme to join another scheme (with a savings account) any balance of the savings account would be transferred.
- Should a member decide to join a scheme that has no savings component, the money in the previous medical savings account is paid out to the member
The above article was contributed by Werner Stoltz. Werner is an independent broker, who is able to advise and arrange medical aid for all of South Africa’s main medical aid companies.
Werner can be contacted here.
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