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Family Medical Aid – Choosing your Family Medical Aid


Points to Consider when Choosing your Family Medical Aid

Family medical aid has become as important a part of South African life as vehicle insurance and mortgage bonds. It has been reliably estimated that greater than 90% of the revenue generated by the private healthcare sector is derived from payments made by these specialised insurers. Furthermore, without such subsidies, only around 5% of the patients who are now treated in private clinics or by private specialists could have actually met the high cost of their treatment out of their own income or savings. Given the crushing pressure already experienced by state health facilities, they could certainly not cope with the additional numbers that this would entail.

When choosing a family medical aid scheme, it is therefore important to be certain that the cover it has been designed to provide will actually prove adequate to meet the needs of both the main member and the named beneficiaries. Even for those who enjoy near perfect health, there is always a danger of the unexpected, such as a motor accident or an acute appendicitis. So, while many of the nation’s citizens may be unable to afford private healthcare cover, few can afford to be without it either, especially in the light of the overburdened state-funded services.

The way things stand currently, the bulk of the premium charged for family medical aid products is applied to the main member with relatively small additional amounts being levied for, including the additional cover that is required for his or her dependents. The nominal addition is independent of the possibility that any of these may actually incur the highest costs although, should anyone covered have a pre-existing condition, it may delay eligibility for the first claim related to that condition. Currently, the law does not permit separate cover for those aged under 18 and while it is fine for spouses to obtain separate cover, minors must always be included as a beneficiary in the family medical aid of a parent, some other relative or some willing older party.

Choosing the most appropriate cover then involves evaluating one’s most likely needs and comparing the relative costs of those products whose conditions and range of benefits appear best able to satisfy them. Since 1998, it has been compulsory for all of a scheme’s products to cover certain prescribed minimum benefits (PMBs), including treatment for 25 chronic diseases and the Council for Medical Schemes (CMS) was appointed to oversee the practices of the nation’s healthcare insurers.

The extra cost of covering PMBs has meant that other benefits and conditions have needed adjustment and so if you are evaluating a family medical aid product, you will need to look carefully at both your known and your anticipated requirements. Those who might be planning a baby, for instance, will need to be quite certain that the cost of pre- and post-natal care is adequately catered for, as are paediatric visits, vaccinations and so forth. If the children are a little older, the cost of corrective dentistry could prove substantial, unless also provided for.

The premiums of many schemes contribute to non-essentials, such as consumer discounts and other fringe-benefits. At KeyHealth, however, we specialise in products that deliver the vital core benefits that are essential to your healthcare with affordable family medical aid that works.