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An Authentic Medical Aid Option for Discerning Individuals and Families

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An Authentic Medical Aid Option for Discerning Individuals and Families

In order to function as an authentic medical aid scheme in South Africa and to offer various options to assist with the payment of private healthcare expenses for discerning individuals and their families, a company must first be registered with the Council for Medical Schemes (CMS). Established in 1998, its responsibility is that of an industry regulator tasked with supervising the financing of private healthcare by the nation’s ninety or so active schemes and ensuring that they comply with the terms defined by the same act that established the council’s formation. In addition, the CMS acts as a liaison and advisor to the minister, and a mediator in disputes between registered schemes and their members.

The introduction of greater regulation within the industry has led to marked improvements in the way medical aid companies are required to operate. For instance, they no longer retain options such as the right to refuse membership on the grounds of a pre-existing illness – a practice that, in the past, created difficulties for many discerning individuals or for one of their dependent family members.

Another huge gain for South Africans covered by these schemes was the introduction of prescribed minimum benefits (PMB). One of the most significant benefits of this move has not only meant that scheme managers may not refuse cover to those with certain chronic illnesses or charge them exorbitant premiums if accepted, but it is now also a legal requirement for all of their products to fully cover all costs relating to a list of 25 chronic conditions identified by the act.

Given both the increased oversight and the mandatory extension of basic benefits, one might certainly imagine that all of the country’s medical aid schemes now provide authentic, affordable and relevant options that have been designed to suit the needs of all individuals and their families. As with most assumptions, however, the reality can often be rather different.

Schemes are required to make their terms clear to members – stating exactly which items and services will be covered, and under what circumstance cover will and will not apply, along with details of the financial support applicable in each case. All too frequently, however, such details are expressed in legal and medical terms that can be confusing and even misleading to a layperson.

Maintaining a sufficiently large membership is important to the stability of a medical aid company, so many have introduced options to attract new members, offering them everything from loyalty points that can be exchanged for consumer goods, to discounted gym memberships and cheap movie tickets. Experience has shown us that something free usually comes with a concealed price tag. In the case of healthcare cover, the more discerning individual will often be aware that its cost is likely to have been met at the expense of core benefits that could prove important to them and their families.

Much of the success experienced by KeyHealth during nearly 50 years in the industry can be attributed to our insistence on providing comprehensive cover with clearly defined benefits that represent the core needs of our members and satisfy them with products designed to meet most budgets. KeyHealth is a name synonymous with value, dependability and authentic medical aid options for discerning individuals and families.

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