Affordable Medical Aid – Answers on FAQs
We have answered a few of the frequently asked questions about affordable medical aid schemes in South Africa to help you gain insight regarding the differences and similarities among medical aid schemes in the country.
What is an open medical aid?
It is a scheme that is open to anyone who wants to become a member and is willing to pay the monthly membership contribution, as opposed to a closed scheme only open to a specific group of people, such as people working in the public administration sector.
What is meant by day-to-day expenses?
These expenses are the costs associated with medical treatment and products received out-of-hospital.
Does a scheme have the right to terminate a person’s membership?
Yes. The scheme can do so if you belong to a closed scheme and have resigned from the company which belongs to the scheme. The scheme can also do so if you have defaulted in paying your monthly contribution; or have lied in your application to join the scheme; or if you belong to more than one scheme at a time, which is completely illegal.
Can the dependants still belong to the scheme if the main member dies?
The dependants can belong to the scheme if they notify the medical aid about the passing away of the main member and arrange for further membership if it is an open medical aid.
How does a medical aid savings account work?
It is an account where a portion of the member’s contribution fees are kept for the payment of the day-to-day services and products. However, one cannot pay for the in-hospital treatments from the savings account and should you not have used the entire amount for the applicable year, the amount is carried forward. When you terminate membership, you will be entitled to the surplus still in the savings account.
Why doesn’t a medical scheme give me the option of a no-claims bonus?
According to the Medical Schemes Act of South Africa, medical aids may not provide members with no-claim bonuses.
Why does the scheme require pre-authorisation for certain procedures and hospitalisation?
The system of pre-authorisation helps to keep the medical aid affordable. It furthermore helps to prevent fraud, over-charging and unnecessary procedures. Indeed, pre-authorisation also helps to protect the member against exploitation.
How is the late joiner fee calculated?
The penalty is calculated according to the number of years that the member hasn’t belonged to a medical scheme and is calculated as a percentage of the monthly contribution. This percentage is then added to the monthly contribution.
How does one go about in choosing an affordable medical aid?
First review the scheme’s history. A scheme that has a long history and has many members will be financially more stable. With more members, the scheme can also ensure more affordability and better cover for the members. Select a scheme that has a wide network of designated service providers and offers you several benefit options to meet your budget and health care requirements. Also check whether the scheme is registered and thus legitimate. Review the add-on service offerings, communication channels, claims processes and the amount of information the scheme provides its members.
