Medical Aid

Medical aid (often referred to as a “medical scheme”) is a type of insurance that protects you against significant unexpected medical costs. When you sign up for medical aid, you agree to pay a monthly premium or a contribution in return for financial cover that will help you to pay for medical treatments and other medical expenses as they arise.

Depending on your medical aid plan and the terms of your provider, a claim can be made and paid out in one of two ways:

1. If your healthcare provider is registered with your medical scheme, then they will submit a claim request on your behalf and they will receive direct payment to cover your medical expenses.

2. If the hospital or medical practitioner you visit is not registered with your medical aid provider, you will have to pay the medical bills out of pocket and then submit your claim to your medical aid company so that they can reimburse you accordingly.

The amount of cover you will get from your medical aid will depend on the type of plan you agree to. Typically, your cover will always include a minimum set of benefits (such as in-hospital treatment and treatment of chronic conditions). But if you subscribe to a more comprehensive medical aid plan, then your prescribed medicine, your day-to-day visits to your regular GP, and your visits to your dentist will also be covered.

Your cover may be limited if you have any pre-existing medical conditions or if there are any other risk factors associated with your lifestyle - for example, do you participate in any dangerous sports or hobbies?

Essentially, the right medical scheme option will provide the benefits you and your family need in conjunction with what you can afford to contribute towards your scheme every month. In South Africa, the Medical Schemes Act governs all medical aid companies to ensure that the industry remains transparent and fair in terms of how much cover one is given in relation to the monthly contributions made.

The world isn’t ideal and sadly sickness and injury do exist. And while there are public healthcare options available to South Africans, there is a remarkable difference between the standard of healthcare that’s provided at government medical facilities and at private institutes. If it’s in your means - wouldn’t you want you and your family to have access to the best medical services available?

Having a reliable medical scheme in place means that you can have peace of mind knowing that your medical bills will be covered in scenarios where hospitalisation is required, regardless of where you are treated. You can also rest easy knowing that you will never experience financial strain and that your loved ones will always be provided for with regards to the following cover:

• In-hospital treatments and surgeries
• Critical illnesses and injuries
• General GP visits
• Dental procedures
• Psychiatric assessments and counselling
• Prescribed medication

When taking out medical aid, it’s important that you do not confuse this type of cover with “medical insurance”. Medical Aid and Medical insurance are two separate products and they will meet your needs differently.

Medical aid will cover your medical bills as they arise and includes a broader category of benefits - for example, it will cover the costs to treat minor colds and cases if flu.

Medical insurance, on the other hand, will pay-out to cover one lump sum or a set maximum amount per incident. The money from a medical insurance fund will be paid directly to you and can be used to cover expenses incurred as you see fit.

Because medical insurance is relatively cheap, many apply for both medical aid and medical insurance so that they extend their cover.

Joining a medical scheme in South Africa is an easy process and it’s not often that a medical aid company will disqualify an application. In fact, medical aid schemes are obligated to accept all South Africans - although they are entitled to impose waiting periods, late joining penalties, and or exclusions where applicable.

You will find that many medical aids are willing to provide cover to:

• Adults
• Children
• Pensioners
• Students
• Pregnant Women
• Newborn babies

• Waiting Periods

  Medical aid applicants are governed by two forms of waiting periods. There is a waiting period that can last 1-3 months which applies to all first-time members, and a 12-month exclusion period for those who have pre-existing medical conditions.

  *Please remember that if you have fallen pregnant before applying for cover, then your pregnancy will be considered as a pre-existing medical condition.*

  As a medical aid member, you are obligated to pay monthly contributions during the waiting period even though you are not immediately entitled to any benefits.

• Late Joining Penalties

  If you are older than 35 and have never belonged to a medical aid scheme before, then your medical aid provider may add late joiner penalties to your monthly contributions. These penalties might also apply if you have had breaks in cover that measure longer than 90 days.

  The best time to join a medical aid is when you are young and healthy. If you are a youth and dependant on someone else’s scheme, then you will be covered up until the age of 21. Once you turn 21, then this is a good time to join your own medical scheme or you can request to be added as an adult dependant on your parents’ or spouse’s medical aid plan.

Most medical aids use a rate calculator to determine a fair monthly contribution. This contribution or premium will be determined by the type of plan you are taking out i.e. do you only want to apply for basic benefits (such as in-hospital treatments) or do you want comprehensive cover with all the benefits plus access to additional perks? If you will be adding a life partner, children or other family members onto your scheme, then this will also be added to your monthly premiums.

Most medical aids also take your lifestyle factors into consideration when calculating a contribution that they rate as fare. They will look at your:

• Age

  If you are older than 35, then your contribution will incur late joining penalties. Generally, the younger you are when you join a scheme, the lower your contribution will be.

• Health Status

  If you drink excessively, smoke or have any other unhealthy habits, then these factors could have a negative effect on your premium. Any pre-existing medical conditions may also result in a higher contribution.

• Occupation and Hobbies

  If your occupation is one that can be hazardous to your health or if you partake in any dangerous hobbies, then you can also expect your premium rate to increase with these “risks”.

• Your Income

  Some medical aids will consider your income when calculating your premium and you might be requested to contribute more if you are in a higher earning bracket.

  In South Africa, medical aid members qualify for a tax rebate on their contributions when they submit their annual tax returns.

From quick visits to your GP to basic day-patient procedures, medical bills can be crippling, especially when they are unforeseen. This is why even the most basic medical scheme will help you to lift financial strain in the event that exorbitant medical bills do arise. While the contribution may take up a large portion of your monthly budget, in the long run, it can prevent you from going into debt just to cover the costs of medical procedures for you and your loved ones.

To get cheap medical aid, we encourage you to join a medical scheme as soon as you can because the younger you are, the lower your rate will be. We also urge you to shop around for competitive quotes. Websites like Money Expert make comparing quotes from different providers quick and easy.

With so many medical aids and insurance companies in South Africa, you should be able to find a quote that will support your budget, your lifestyle, and your needs.