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Detangling the Facts About South African Medical Aids


When the topic of choosing the right medical aid comes up in conversation, it is instantly met with various opinions on which one is best, which one would be perfect for you, and which one to stay away from. Generally speaking, each person swears by a different plan or different medical scheme to be the “only option” there is out there if you want to do it right. We’re not saying everyone else is wrong – all we’re saying is that choosing the right medical aid is deeply specific and personal. Although words of advice and cautionary tales can be helpful when trying to find the right medical aid, it is also easy to get lost in all the different opinions and contrasting thoughts and feelings.

It can take time to detangle all the things that you need to know from what’s just plainly false or misinformation. To help you navigate the seas of application forms, jargon, and the complicated fine print, we’ve decided to take it way back to the basics. Take a look at our answers to the most common questions and misconceptions about South African medical aids.


The 100% Cover Myth

It looks really impressive at first glance. Surely, when your medical plan states that you are a 100% covered then you won’t have to pay anything yourself, right? Wrong. In most cases, this means that you will be covered for 100% of the national medical fund tariff. This set price is an estimate of how much certain procedures and medical expenses may cost. However, this estimated price could be considerably lower than what private doctors or private hospitals charge – leaving you with having to make a substantial co-payment. To avoid this situation, numerous people take out a Gap Cover Plan that will fill the gap between the two prices.


The Doctor Dilemma

Many individuals who first sign up to medical aid, or who are looking to switch medical aids, are worried that they would have to move to a new doctor. Depending on which plan you choose, this may or may not be the case. If you would like to stay with your current doctor, you can easily see which network doctors are covered by your plan. Your specific GP could very well be on that list. Alternatively, you could opt-in for a plan that covers in-hospital procedures only, which will lower your monthly premium but allow you to stay at your preferred doctor at your own cost. The most important thing to remember is that no medical aid can force you to go to a specific doctor. They could encourage some above others, but the choice is still up to you. The best way to ensure you stay with your specific doctor is to talk to your medical aid provider as well as your doctor to ensure everyone is on the same page – especially you.


You Need a Broker to Get the Right Medical Aid

Although brokers can be very helpful when looking for the best options for you and your family, the process shouldn’t have to be overly complicated and difficult to understand in the first place. At KeyHealth we aim to make the process easy to follow and the benefits clear and concise. Your medical scheme should also be easy to reach and available to answer anything that might be confusing or ambiguous during the entire process.


Good Medical Aid is Too Expensive

Good medical aid doesn’t need to break the bank. When choosing the right medical aid, the most important thing is that it is tailored to prioritise your specific needs. Once your plan is customized to fit your budget, needs, family size, and health, you will come to find that it is very affordable, especially when comparing it to the grim reality of what would happen if there were to be a situation where you’d have to pay the medical expenses out of your own pocket. When planning your budget, keep in mind that you will have to make the payments on time to ensure that you are covered at all times.


Medical Aid vs Hospital Plan

If you’re in the process of finding the right medical aid or hospital plan, we’re sure that by now everything looks more or less the same and just as confusing as the next one. Before you carry on browsing the web, it’s important to know the main difference between a hospital plan and a medical aid. In a nutshell, a hospital plan will only cover you when you are hospitalised. It’s also important to note that not all hospital plans cover the same benefits. The first step would be to consider which benefits you prioritise the most. If you are constantly at your GP, it may be beneficial to find a plan that covers your visits. Many people start with a basic hospital plan, as it ensures that, at the very least, you are covered in an emergency or when things go awry and you can’t afford the hospital bills.



At the end of the day, you should feel free to contact your potential medical aid provider whenever you feel uncertain or have doubts. At KeyHealth, we aim to keep it as straightforward and clear as possible, right from the get-go, ensuring little to no confusion down the line.

If you have finished the article and still have a few questions, or if you’d simply like us to guide you through the process, feel free to give us a call. One of our team members would be more than happy to assist you with any enquiries – it’s what we’re here for! For a full list of our specific KeyHealth services, visit our website and learn more about what we can offer you.