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With more than 30 medical aid schemes with open membership operating in South Africa, it may seem a difficult exercise to choose the best one amongst them. Add to this the fact that each medical scheme has a number of different “plans” or packages based on what members typically need and what they can afford to pay for medical cover, it may seem an intimidating task indeed. However, there are a number of factors to consider when searching for the best medical aid for you and your dependants.
The financial health of a medical aid
The first factor you should consider when evaluating a medical scheme, is its financial standing. An alarming fact is that since 2000, 44 medical schemes in South Africa have ceased to exist – some as a result of liquidation, while others have been swallowed up by mergers.
The Medical Schemes Act, 1998, requires that medical schemes have a solvency rate of at least 25%: this means that it will be able to honour all its claims even if it did not receive membership contributions for three months. In 2009, 20 medical schemes failed to maintain a solvency rate of 25% – although this does not necessarily mean that they were in danger of going bankrupt, it is an indication of financial health.
Another indicator is how well a medical scheme has performed over the preceding two years. You can ask your General Practitioner about his or her experience with various medical schemes and their ability to settle claims.
The administration of a medical aid
You can also consider the history of a medical scheme, whether it has been involved in lawsuits, whether its membership is growing, whether its membership profile has changed, what percentage of payments it is spending on health care benefits as opposed to administration costs, what kinds of benefits it offers and how these compare to other medical schemes.
Have the medical scheme’s contributions increased recently, and by how much? Bear in mind that contributions may increase sharply one year (often in response to an increase in membership and a need for increased solvency), only to level off the next year.
A medical aid’s client relations
Does the medical aid communicate in a friendly, open and transparent manner through its website? Is the information presented in a way that is easy to understand? Are the staff at its call centre friendly, efficient and helpful?
Some final advice
The schemes with the highest customer satisfaction ratings are Fedhealth, Momentum, Bonitas, BestMed, Genesis, Medihelp, Liberty Health, Discovery, Medshield and Spectramed.
According to a 2011 Alexander Forbes Health analysis, the best value-for-money medical schemes in South Africa are Momentum Health (the Momentum Summit plan) and Discovery Health (the Discovery Essential plan).
Ultimately, however, the best plan for you and your dependants will be determined by your particular needs and circumstances.