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.
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.
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.
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.
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.
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.
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.
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.
Having proper medical aid cover is ‘n huge benefit to have; especially since you never know when you will need it. There are many medical aid schemes in South Africa and they all have different benefits and pricing structures available; which is why you should always compare plans and benefits before you choose a plan for you or your family.
Choosing a medical aid can be quite time consuming, because they all have different plans to offer, and different fees as well. With benefits that can vary so greatly between medical aid service providers, it is always a good idea to do your homework and properly compare them before you make your decision.