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Deciding Which Healthcare Plan May Best Meet Your Needs


2020 was a rude awakening for many South Africans. The pandemic highlighted the need for a healthcare plan, revealing that even the healthiest are vulnerable. For many years, we had access to a state-funded health system to meet all our medical needs at no charge for the unemployed who could not afford it, while everyone else was treated for a nominal fee.

Unfortunately, as demand grew and operating costs increased, the state’s contribution gradually became insufficient to maintain services of a standard comparable with that of the private sector. Many higher-paid citizens turned to the latter for help and were content to pay the substantially higher tariffs. For the less well-off, medical aid schemes were established to provide some welcome financial support to meet the high cost of private medical treatment.

Ensuring your workforce is healthy is one of the best ways to promote staff loyalty and ensure optimum productivity. To that end, many companies arrange for their employees to enjoy more affordable healthcare plan premiums through a closed group membership scheme, while others are required to pay more to enjoy the same benefits. Joining one of the open medical aid schemes may be the only way to ensure top-quality treatment whenever they are ill or injured.

Since the peak of the medical aid industry in the ‘60s, its numbers have gradually dwindled. Around 76, of which only 18 are open to all, are still operating today. If your employer has a group scheme, you will have no worries. However, if not, you must choose an open healthcare plan that will best meet your needs, but how should you decide?


Choosing Your Healthcare Plan

Given the current economic downturn, price is frequently a concern for many seeking support with their medical expenses. However, like retail goods, a medical scheme’s products come in a range of prices, ensuring there should be something to meet most budgets and healthcare requirements. Choosing a plan you are confident you can afford is essential, as missing a monthly premium could leave you and your family without cover. It will help to become familiar with the following three healthcare plan options available from medical schemes:

  • Fully comprehensive cover: This is often the best option for families, especially parents with small children. Membership includes unlimited cover for emergencies and other conditions that require hospitalisation and generous support with day-to-day costs like GP or specialist consultations, prescription charges and over-the-counter medications. A scheme may offer a choice of fully comprehensive properties with different benefit limits and will be priced accordingly.
  • The hospital plan: Although this is an entry-level product and the cheapest medical aid option available, many people find it provides all the support they need. It’s ideal for young and single individuals with good general health but modest incomes. A hospital plan will cover most and possibly all expenses incurred whilst an in-patient, but there will be further benefits after you are discharged.
  • Intermediary products: This type of healthcare plan may best be described as an augmented hospital plan. It is a hybrid option that combines unlimited cover while confined to a hospital with variable levels of support with private medical expenses incurred at other times. Some stipulate the conditions included and claim limits, while others may have a medical savings plan that enables members to choose what they wish to subsidise.


Terms and Conditions Governing a Healthcare Plan

The following apply to all schemes and should not influence your choice:

  • Prescribed minimum benefits, including mandatory cover for 26 chronic illnesses
  • A late joiner fee will be applied to applicants who join a scheme after the age of 35. After that, the penalty payment will be increased for each additional year without cover.
  • Mandatory waiting periods will apply to first-time members, those without medical aid during the three months before applying and members with pre-existing conditions without prescribed benefits.

These conditions are necessary because medical schemes are non-profit companies. They discourage opportunists from enrolling to pay for expensive treatments and resigning once their claims have been met, leaving loyal members at risk of unmet claims.


Why Choose a KeyHealth Healthcare Plan?

The short answer is that we are a well-established, trusted and respected scheme founded in 1968 and have an enviable record of paying our members’ claims in full, on time and without objections. Contact us to learn more about our products and free added core benefits and ensure peace of mind for you and your