Category Archives for Tips & Advice

10 Most Common Medical Aid Terms

Medical aid jargon can be pretty confusing to say the least…

In today's world, many of the most commonly used terms have been reduced to acronyms and other jargon. There is industry-specific jargon which can be confusing for the average citizen to fully understand, particularly when it comes to medical aid.

Having an understanding of the terminology will help you to better understand what each of them means. Let’s take a look at some of the more common ones.

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The 10 best to worst medical aids by complaints

Medical aid schemesMedical aid companies receive many complaints. Often this stems from a lack of understanding of how the plan works.

Many people do not read the fine print until there is a dispute. The best bet is to study or have an independent broker explain the details of the plan to you.

That being said, there are defiantly some medical aid companies that offer better service than others.

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Top Medical Aids

South Africans are spoilt for choice with the many medical aid schemes that we have at our disposal. Some offer basic medical care, whilst others offer quality care and tailor-made packages to suit your every need. Then the cream of the crop goes on to provide wellness programmes and discounted gym memberships in an effort to encourage a healthier South Africa. The turnaround times on claims and quality client service is also of high standard.

Depending on your age, family situation and budget, there is a good plan to meet your needs.

Here are the top ten medical aid companies by membership. The results are not surprising.

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Who qualifies as dependents on a medical aid?


At first glance, the rules as to who qualifies as a dependant on a medical aid scheme might appear a little confusing. It is actually pretty straight forward and while pricing and certain conditions might differ from one provider to another, the basic rules are quite clear and apply to all South African medical aid schemes. The rules are dictated by the Medical Schemes Act and in short, state that no person dependant on a member may be refused admission to the plan.

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What is a comprehensive medical aid plan?

Many people take the word comprehensive to mean that everything is covered. They feel this way about vehicle insurance as well as medical aids. It is only when they have a major accident or a lengthy hospital stay that they realize the plan is not quite as comprehensive as they had assumed.

There two main types of medical aid product in South Africa and those are hospital plans and comprehensive medical aid. The former is, as the name suggests, merely a hospital plan and will cover you for a range of hospital producers, trauma, emergencies and xxx. They also cover the Prescribed Minimum Benefits (PMB) as regulated by the Medical Schemes Act. These include emergency conditions, 25 specified chronic conditions and a list of 270 medical conditions. They do not make any provision for day to day expenses, doctor, dentist or specialist visits and medication. They seldom cover the full cost of hospital treatments and doctors’ bills and have specified limits for different conditions and procedures.

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What You Didn’t Know About Day to Day Services

Day to day services

While most medical aids plans will cover you for emergencies and hospital treatment, day to day expenses can add up very quickly. Even a good medical savings account (MSA) can be depleted in a short space of time, especially with the whole family sharing the savings. Some medical aids make no provision for day to day expenses at all. It just takes a few rounds of something like the flu or tummy bugs and suddenly the bills are adding up.

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What is the medical aid savings account (MSA)?


The medical savings account or MSA is a relatively new feature that is now common to many of the top medical aid plans. Despite how prevalent they are, many people still find them quite bewildering and battle to fully understand how they work. It is important that a member grasp the concept in order to get the most out of it. Not understanding it correctly could leave you out of pocket or without the means to pay for treatment or medication.

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What is a self-payment gap?

Depending on your circumstances and medical expenses through the year, you may well deplete your medical savings account before the year is over. If you and your family have a healthy year with minimal day to day expenses, you could carry money over to the next year. If you have one or more members needing doctor or dentist visits and medication, the opposite might happen and your funds could easily dry up long before the end of the year.

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National Health Insurance

The Health Insurance industry of South Africa is one of the most lucrative in the entire African continent. Typically, one of the policies and insurance providers in the area is the government financed system referred to as the National Health Insurance. The coverage of the NHI or the National Health Insurance is applicable for all the citizens of the country. Healthcare essentials for each and every person are covered to the stated value of the disease, and this is applicable for everyone regardless of their employment status and their ability to contribute to NHI.

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The Medical Aid Ombudsman (everything you need to know)

medical aid ombudsman

The medical aid ombudsman is a body that one can approach for recourse concerning a number of different issues that relate to your medical aid scheme or service provider, or any other issue related to your medical aid. This can also include the end service providers who are contracted through that particular medical aid or who are a pert of that medical aid scheme.

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