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Can All South African Medical Aid Schemes Provide Cover to Suit Every Lifestyle and Budget?


People’s healthcare needs vary widely, as do their monthly incomes. Ideally, medical aid schemes must attempt to provide for every lifestyle and budget. In practice, anyone seeking help with private healthcare expenses must generally obtain quotes from several companies and decide which best suits their needs. Some brokers assist the search process by providing online comparison sites, enabling visitors to get multiple quotes with a single enquiry. However, not all schemes choose to be listed on these sites.


Medical Aid Schemes in South Africa Offer Two Main Forms of Cover

Even before the establishment of financial support with private healthcare, insurance companies recognised the need to help those who are ill in hospitals. To meet their needs, insurers developed the hospital cash plan that pays policyholders a fixed cash sum for each day as an in-patient. For those receiving state-funded treatment, it can help compensate for lost income or meet incidental expenses. However, the daily payments fall well short of the big bills associated with private healthcare. Ultimately, increased dependence on private treatment and the shortfall of cash plans led to the formation of the dedicated medical aid schemes we know today.

These schemes are of two types; closed and open. The former are group schemes, and membership is restricted to employees of a given company, members of a specified profession or professional body and similarly defined groups. Anyone without group cover can apply to an open scheme, of which 18 operate in South Africa. Members can choose between two forms of cover. Most companies offer a choice of at least five or six products, priced according to the benefits included. At the top end of the spectrum, the cover is fully comprehensive and will thus meet most, if not all, of the member’s private healthcare expenses, both as an in-patient and an outpatient. However, the need for a more affordable option led schemes to develop a modified version of the hospital cash plan.


Medical Aid Schemes’ Hospital Plans are the Most Affordable and Viable Option

These products don’t pay the inadequate daily cash sums typical of an insurance company’s cash plan. Instead, they undertake to cover most, and often all, of the cost of accommodation and treatment whilst the member is confined to a private hospital or clinic. In their most basic form, they include no day-to-day benefits, so members must pay for GP and specialist visits, prescription charges and any other private healthcare services they receive as an outpatient. Alternatively, they can utilise the state-funded health service.

The hospital plan is central to all medical aid products, as hospitalisation and surgery incur the highest costs. However, a range of intermediary options that fall between cheap entry-level plans and top-of-the-range, fully-comprehensive products is necessary to meet all lifestyle and budget needs. These products include a graduated range of day-to-day benefits commensurate with the member’s healthcare requirements and disposable income. The KeyHealth medical aid scheme addresses these needs with six purpose-designed products. A brief outline of each follows.

  1. Essence: This product offers excellent value for anyone seeking low-cost critical cover for those just-in-case situations. This unlimited private hospital plan also offers selected out-of-hospital services at cost and year-round coverage for 26 chronic illnesses, including asthma, diabetes, epilepsy, hypertension, ulcerative colitis and multiple sclerosis.


  1. Origin: In keeping with the concept of graduated benefits, for a marginally higher premium, members choosing this option will enjoy all the core benefits of Essence with some valuable additions, like help with ophthalmology and conservative dentistry costs.


  1. Equilibrium: This product is ideal for those who need an affordable product that meets all in-patient needs and are happy to choose how they manage their day-to-day private healthcare expenses. An integrated savings plan enables members to settle their outpatient costs as required.


  1. Silver: This product offers good value for families who may need a more-than-average level of healthcare. Silver includes enhanced day-to-day cover and benefits for three additional chronic conditions, plus dental cover and extra GP visits for kids.


  1. Gold: The Gold option combines Silver’s benefits with cover for 44 chronic medical conditions plus extended dental cover, increased savings and out-of-hospital mental health cover.


  1. Platinum: Platinum membership is the most comprehensive KeyHealth option for those families who wish to provide for all present and future needs.


KeyHealth Medical Aid Scheme Offers Three Valuable Core Benefits for Free

You will notice that each KeyHealth product includes Health Booster, our Smart Baby programme and Easy-ER at no charge. Why not click here to join and start benefiting today?