Compare Medical Aids: Basic Information
Before you make a long term decision regarding cover for out-of-hospital and in-hospital services, take the time to compare medical aids. It is imperative that the Medical Scheme will offer comprehensive information rather than window dressing. We believe in helping you make informed decisions and as such make it easy to compare medical aid benefits from each of our packages.
In addition, we also provide more information on questions you may have regarding medical schemes, allowing you to be informed before you compare the various packages and services offered in South Africa.
Medical Scheme Dependants
According to the Medical Schemes Act No. 31 of 1998, a scheme may not refuse a dependant of a member if the dependant is under the age of 21 and is an immediate family member. The same applies for a member that is over the age of 21, but lives with the member and is dependent on the member because of a physical or mental disability or is still a financial dependant of the member. The member must be legally obliged to provide family care to the person. A spouse living with the member is also a dependant.
Immediate Family
A spouse or child can be a dependant and qualify as immediate family. Note that specific conditions, some of which are already discussed, apply. If your child is thus over 21 and not living with you, the child is no longer a dependant.
An ex-spouse is not a dependant unless the court has specified that you should award medical benefits to the person, which may be the case in a divorce. Only then, can you keep your spouse registered. Note that should you remarry, the new spouse can be added to the Scheme and their children or adopted children now forming part of your immediate family can also be added.
Death of a Member
Should you as the member die, your dependants will still be covered by our Scheme, provided that the monthly contributions are paid. If they no longer wish to continue as members of the Scheme, they must notify us in writing immediately to avoid being liable for contribution costs. It is compulsory to provide notice of termination according to the legislated requirements should you no longer wish to be part of a scheme, but you will be entitled to the benefits during the notice period if the contributions are paid.
Employer Contributions
The Conditions of Employment Act regulates what the employer must do and it is thus recommended that you review the Act for more information on such. Employer contributions are thus regulated. Your employer may specify to which medical aid scheme you must belong or can give you the choice according to specific terms and conditions. It is important to understand that should the employer fail to pay contributions as agreed upon that the medical cover provider can terminate the membership agreement. In an open scheme your membership will not be terminated should you be retrenched or retire as long as you pay the required contributions.
Bonus Payments
The Medical Schemes Act prohibits the payments of rebates or no-claim bonuses other than the contributions to the savings accounts and according to allowable conditions. A scheme is not allowed to increase contributions without adequate advanced written notification of such.
Pre-Authorisation for Hospitalisation and Specific Treatments
You will notice that we require pre-authorisation for hospitalisation and certain treatments. If it is an emergency treatment and the member is not able to obtain the necessary authorisation because of injury or the condition, a family member, friend or hospital must contact us to provide the necessary information and to obtain authorisation for services and treatments.
Upgrading of Options
If you change from one scheme to another after having made a comparison between the medical aids, you will face a waiting period. It is often better to simply upgrade to the next package level, which will allow for an increase in benefit limits. If you want to pay less, simply downgrade to a more affordable package at the same medical scheme.
View our full range of packages and if unsure about the most suitable package contact us to help you compare the benefits of the medical aid packages.
