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Affordable Medical Aid Schemes


Affordable Medical Aid Schemes: Information on Membership

KeyHealth is one of the most affordable medical aid schemes in South Africa, still offering comprehensive cover according to contributions. We believe in the provision of complete information to help people make informed decisions also when they compare affordable medical aid schemes. As such, some of the considerations, terminology and questions you may have are answered below.

Prescribed Minimum Benefits

The PMB are benefits which even the most affordable medical aid scheme must provide according to the regulations of the Medical Schemes Act No. 31 of 1998. Members of the scheme are entitled to such benefits at Designated Service Providers of the scheme and state hospitals. The Designated Service Provider or DSP is an appointed and approved service provider which the members of the scheme must use if they wish their Scheme to pay the benefits.

Proof of Membership

If you have terminated membership from one medical aid scheme to change to a more affordable scheme, you can request proof of membership from your previous medical aid and for the period you have been a member. If you are unable to gain such documentation from the scheme after having made a reasonable effort to do so, you can produce a sworn affidavit of your membership and period of membership to that scheme.

Imposable Restrictions

Note that a scheme can impose a late joiner penalty and a waiting period should you only join a medical aid scheme later in your life and have not been a member of such before April 2001. Certain conditions apply for such. In most instances a waiting period can apply for pregnancy benefits and in some instances the period can be up to two years.

Difference between a Hospital Plan and a Full Medical Aid Cover

The hospital plan only covers designated service providers while you or one of the dependant members are in hospital and you are still responsible for out of hospital expenses. It is the cheaper option if you only want cover for emergency and elective hospital based procedures. Note that it is different from a hospital insurance plan that pays out cash from day one of hospitalisation. You normally have options of how much should be paid and whether only for you or all your dependants. The cash pay-out option helps for additional expenses.

The full medical aid cover is more expensive than a hospital plan, but covers out –of- hospital expenses as well. The dentist, optical and physiotherapy related expenses, GP visits and out- of- hospital pathology and radiology as well as prescribed medicine and some self-medication according to terms and conditions are paid up to a specific amount as set out by the Scheme and according to contributions.

When shopping for an affordable medical aid scheme consider the following:

  • How much can you afford to contribute monthly?
  • How many dependants do you have and what is the general state of health (yours and your dependants)?
  • Do you or one of your dependants suffer from a chronic disease for which you will require regular medication and treatment?
  • What are the ages of your dependants and you?
  • What type of cover do you need? To determine such consider whether you regularly have to visit dentists, GPs, physiotherapists, and optometrists. If not, you may select one of the lower out-of-hospital benefit plans, which still provide prescribed minimum benefits for hospitalisation and emergencies. If you have hearing or eye problems, you will want a cover with higher day to day limits.

Medical Savings Account

The medical savings account is a fixed amount as determined by your medical scheme. This amount is payable by you and should be placed in a savings account on a monthly basis as part of your contributions. You will be able to use the amount for out-of- hospital costs. Money left at the end of the financial year can normally be carried over to the next year and you thus don’t lose your contributions. Should you change schemes, the money can be transferred to the new scheme according to legislative requirements.

You will find that we offer exceptional affordable medical aid cover in all our packages. Whether you select the basic Essence, Equilibrium, Silver, Gold or Platinum package, you can expect only the best and most professional service from KeyHealth.