Introduction to Medical Schemes in South Africa
Medical schemes in South Africa are regulated by the Medical Schemes Act No. 131 of 1998. The Council of Medical Schemes is the statutory body established by the Act to supervise the schemes. The Minister of Health appoints an executive board to manage the Council. With over 97 medical aids registered in South Africa, the Council has a massive task in ensuring full compliance with all regulations.
Two main types of medical schemes exist in South Africa:
- Closed or Restricted.
Closed or Restricted Schemes
Such schemes only offer membership to a specific group such as employees of a particular company.
Such schemes, of which KeyHealth is an example, offer membership to all contributing members and don’t discriminate regarding membership on any grounds.
Difference between Healthcare Insurance Providers and Medical Schemes
Medical cover was initially introduced in the USA in the early fifties, but South African related health insurance only dates back to the eighties. Medical aid schemes, however, differ from health insurers in the sense that the health insurers pay out specific amounts for hospitalisation or conditions.
Medical schemes on the other hand, agree to pay for services according to the agreed upon tariffs for treatments, hospitalisation, and day-to-day care costs of members in return for monthly contributions.
Paying members can therefore make use of healthcare services and treatments authorised by their medical scheme on a regular basis. With healthcare insurance, the money may be paid out to the member once off or for a specific period for the treatment of a condition.
An example of a health insurance product is that of the dread disease where the individual takes out insurance against the risk of becoming disabled or suffering from a dreaded disease. A lump sum is paid out should the person become ill with the condition.
The medical schemes in South Africa don’t pay-out lump sums to their members, but pay for the health services, medicine and treatments received by their members. Most medical aids settle the healthcare accounts of their members directly with the service providers. In some instances, the service providers may ask a higher fee than the tariff the scheme is willing to pay and in such instances, the members need to make co-payments.
Selecting a Medical Scheme in South Africa
With the medical aid companies in South Africa, strictly regulated, one may think that there are no real differences in service offerings and rates. However, when you look at KeyHealth and compare our services, prices, and benefit plans with that offered by other schemes, you will notice that we stand out for the following reasons:
- Affordable cover options according to member requirements.
- Extensive range of packages to fit the member health requirements and budgets.
- Excellent communication infrastructure for improved customer service which includes a webmail and SMS system, newsletter, online chat facility, authorisation centre, service centre, and walk-in offices.
- Proven track record of claim payments and good standing with service providers.
- Large membership pool and the ability to keep premiums low.
- Add-on programmes for preventative healthcare including the Disease Management Programme.
- Open communication with members regarding tariffs and policies.
- Adherence to sound ethical practices.
- Pre-authorisation system in place to ensure optimal management of treatment costs.
We have a long history of service provision in the country and because of our experience in the industry we can design suitable benefit packages. Our website contains all the information you need to make an informed membership decision and we also have consultants waiting to assist with more information.
View our range of products and contact us for immediate professional assistance in determining monthly contributions and to explain our benefit plans.