Shopping around for the best medical aid for you and your loved ones is a daunting task. There are many factors to consider and it is an extremely important choice.
Medical Schemes Act
All medical aids in South Africa are governed by the Medical Schemes Act. This offers you protection and recourse in the case of a dispute.
Look at how long the medical aid company has been around and the size of the scheme. There are some very good smaller medical aids but often the bigger ones are a safer bet.
Legislation and the Medical Schemes Act do ensure the fund has sufficient reserves (their solvency ratio) but it will not hurt to look into their financial stability.
Personal & Family
You then need to take a look at your personal and family medical history. Where and how do you use medical facilities? Although emergencies and unexpected medical conditions can occur, your general medical history will help you decide on a medical aid company as well as the best plan to select. Your age and that of your dependents will also factor into this.
Look at any special needs, chronic conditions and family history of disease. When studying the options, consider these factors.
You will also have to consider your budget. While it is great to have the best cover possible, this is not always financially feasible. Be realistic about what you can afford.
Do you need a medical savings account (MSA) for day to day expenses or can you save on this expense while still having enough cash available for when these costs do occur?
Consider annual limits. This can be a time-consuming task but is necessary to understand. A plan with fairly low limits may be more affordable but then you might need to consider the additional expense of gap cover. The same is true of co-payments for certain procedures or specialists. Be aware of these when making your decision.
Look at what procedures, specialists or hospitals are restricted. Some plans only allow you to use specified doctors and hospitals.
Do a bit of homework online to see the general service levels and complaints that are expressed. Even the best companies have complaints so do not be put off by a handful but look for patterns.
Those are a few of the more important factors to look for but medical aid schemes are extremely complex. It is a difficult and time-consuming exercise to do oneself. A good independent medical aid broker will be able to do an analysis of your needs, explain the options and give you sound advice.