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The Challenge Facing South African Medical Aids


The market for South African medical aids is highly competitive. Consequently, most schemes now offer incentives to help maintain viable membership numbers. A steadily worsening economy has further heightened the intensity of competition between medical aid providers.

Affordability has become a major issue in the wake of rampant inflation, but rising prices have not only affected consumer goods; they have also taken their toll on both the public and private healthcare sectors. Despite their best efforts, rising costs have left fund managers with a choice. Do they increase their member’s monthly premiums or reduce their medical aid benefits?

In practice, increases have been unavoidable. However, most schemes have done their best to keep these to a minimum and in line with the Council for Medical Schemes (CMS) guidelines. That said, even these relatively minor price hikes have had an impact. In the prevailing financial climate, prospective members are now more inclined than in the past to compare all the available options before deciding to commit to yet another monthly expense.

Accordingly, most South African medical aids have been adopting strategies that could help them achieve a competitive edge and optimise their membership numbers. At the same time, schemes must ensure they provide sufficient value for money.


How South African medical aids are dealing with inflation

The nation’s Department of Health (DoH) has established tariffs for every procedure performed and medication prescribed by surgeons and physicians in state-funded clinics and hospitals. However, these tariffs are not binding on the private healthcare sector.

Instead, private clinics and medical professionals are free to charge whatever they wish. As a result, schemes regularly receive claims from their members for anything from double to three times the DoH tariffs or more. Like KeyHealth, South African medical aids have found various ways to offset or compensate for this added cost.


  • Incentives

The use of incentives to attract customers is a well-established retail marketing strategy. Rather than allocating loyalty points, some of South Africa’s medical aid schemes provide their new members with more tangible rewards.

However, although discounted gym memberships, free movie tickets and the like may be attractive, the companies subsidising these “free” bonuses are not charities. They require payment which can only be made by increasing premiums or curtailing benefits.


  • Limited cover

While it may be desirable to have fully comprehensive healthcare cover to meet all possible needs, the cost can be prohibitive for many people. To overcome the higher premium issue, South African medical aids introduced the hospital plan.

In addition to shielding members from the potentially crippling costs of surgery and a prolonged stay in hospital following an accident or medical emergency, it also provides the prescribed minimum benefits (PMBs) mandated under the Medical Schemes Act 131 of 1998 and subsequent revisions.

At KeyHealth, we have extended the basic hospital plan to give South Africans the choice of several affordable options with added benefits for individuals and families.


  • Designated service providers

Typically, medical aid companies in South Africa have tens of thousands of members. A guaranteed opportunity to treat those of a particular scheme’s members who become ill can be of considerable value to a private healthcare professional. In exchange, participating service providers are willing to reciprocate with more favourable tariffs.

KeyHealth has recruited a network of designated service providers. It includes private clinics, specialists in all fields, pharmacies, laboratories, and every provision necessary to ensure our members receive the care they require and the best possible tariffs, especially for PMbs.

Our members are not compelled to use a designated provider. Instead, they are free to make their own choices as necessary. Occasionally, it may be more convenient to use a nearby service rather than travel to another town. However, in some cases, doing so might require a member to make a co-payment to the undesignated service provider.


  • Additional core benefits at no charge

The KeyHealth philosophy is to provide our members with real value. One way we achieve this is by enhancing our products’ core benefits. Everything from our entry-level hospital plan to the top-of-the-range Platinum product comes with three invaluable core benefits, free of charge.

As one of the oldest and most trusted South African medical aids, we offer six options to cater to all needs and budgets. Each includes our free “Easy-ER”, “Smart Baby Programme”, and “Health Booster”. Why not contact us to learn more about these and how you can start protecting your family’s health today?