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What to consider when selecting your South African Medical Scheme |
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South African Financial Services – Insurance – Medical Aid – What to consider
The below questions are important items to consider when selecting your most appropriate medical scheme in South Africa.
What is your budget for medical aid?
What do the different medical aid plans offer?
How does the payment structure for each different medical aid work?
Do you have any chronic conditions?
Are you over 35 and are you aware that you may have to pay penalties because of this?
What are the penalties?
Do you fully understand the different medical aid schemes?
Should you get professional advice?
Do different medical aids offer further services and what are they?
What is a savings account and how does it work?
What is a hospital plan?
What counts as a dependent?
What is your budget for medical aid?
This is a major consideration when choosing your specific medical plan. The smallest premium currently is around R600 per person.
What are your personal requirements? (Full cover including doctor’s appointments or just a hospital plan).
Each person’s needs are different, and this should be your main consideration when choosing your plan.
Do you have any special medical problems that need to be catered for? (high blood pressure, bad eye sight, etc).
Each scheme has their own scope of cover that will all differ from each other. Some conditions might be covered by a certain insurer, but not the other.
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What do the different medical aid plans offer?
It is very important that the cover chosen matches your needs. Should you have extensive chronic or other medical expenses, it would be necessary to insure yourself on a comprehensive type of plan. Should you be relatively young & healthy, a basic hospital plan might be sufficient.
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How does the payment structure for each different medical aid work?
Each plan’s payment structure is broken up between cover for hospitalization (including chronic expenses), and day to day medical expenses (out of hospital expenses such as visiting a GP). Day to day expenses will be covered by the savings portion of your premium.
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Do you have any chronic conditions?
Chronic conditions can be defined as a life threatening condition that needs ongoing intervention through medication and / or medical treatment. The more comprehensive your plan, the more conditions will be covered.
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Are you over 35 and are you aware that you may have to pay penalties because of this?
Should you join a South African medical scheme only after age 35, you will incur a late joiner penalty.
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What are the penalties?
The penalty varies depending on your age. Over 35’s pay an additional loading on their premium, structured as below:
| 1-4 years (of break or not being insured): |
5% |
loading on premium |
| 5-14 years: |
25% |
loading on premium |
| 15-24 years: |
50% |
loading on premium |
| 25+ years: |
75% |
loading on premium |
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Do you fully understand the different medical aid schemes?
There is a variety of different schemes, make sure the one you choose have a good grade and meets the required solvency ratio. Each scheme also has different plans available, ranging from basic hospital plans to much more comprehensive plans. Each insurer’s hospital plan for instance will also differ from each other in terms of the actual cover. Some offer the national health rate (for specialists and anesthetists) only, whilst others might offer 300% cover of the national health rate.
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Should you get professional advice?
Yes, always. Medical insurers change their plans on an annual basis. It is important to get advice from someone who keeps up to date with each plan’s structural changes. Medical aid advisors can also assist with claims.
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Do different medical aids offer further services and what are they?
Yes, some insurers offer reward programs that include discounts with various suppliers (such as Virgin active, Clicks, Ster Kinekor). These programs are mostly aimed at promoting a healthy lifestyle.
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What is a savings account and how does it work?
Your savings account is supposed to cover all day to day medical expenses (out of hospital expenses). Normally a portion of your monthly premium would be allocated to this account, and one can opt to contribute an additional amount. This account is available to the insured from day one, and can be used at their own discretion. Expenses like dentists, visits to the GP, pharmaceutical expenses, etc.
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What is a hospital plan?
This is the most basic type of medical schemes product available. Cover is normally provided for hospitalization (including in hospital specialists and anesthetists) and certain chronic benefits only.
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What counts as a dependent?
Generally the following are classified as dependents:
- Spouse or partner
- Children < 21 financially dependent on member
- Children > 21, financially dependent on member due to mental or physical disability.
- Mother, father, brother, sister of member, in respect of whom member is legally liable for care and support; other persons
- Or as recognized as dependants in terms of the scheme’s rules.
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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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