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How Comprehensive Should Your Medical Aid Cover Be?


None of us can predict the future so, when attempting to gauge just how comprehensive our medical aid cover should be, the best we can hope to do is to cater for those needs we are aware of. For example, should you or a member of your family be afflicted with a chronic illness, and so, require ongoing treatment or medication throughout the year, it would be unwise to invest in a hospital plan that provides cover only during those periods actually spent in a hospital bed. At the same time, it is equally important to select a product that is affordable, as any failure to meet the monthly premium payments will result in the loss of your cover.

When applied to private healthcare support, the interpretation of comprehensive tends to differ between medical aids, with some providing more or less cover than others. It can, therefore, be crucially important to take a close look at those benefits that are on offer, and to be certain that those you know to be necessary to you or to any of your dependents are definitely included.

For example, while many funds provide support with basic dentistry, a family with two or three young children could easily find themselves faced with a succession of huge bills for costly orthodontic treatments, for which funding is typically excluded when opting for one of a fund’s entry-level or more basic products. By contrast, unlimited funding for crowns, bridges, partial dentures, periodontics, and orthodontics could all be included under the comprehensive medical aid cover offered by a more appropriate product.

It is possible that you are among the growing number of South Africans affected by osteoarthritis. Typically, your doctor will be treating you with painkillers or steroids, depending on your level of discomfort. If so, you will also have been advised that hip or knee replacement is likely to prove necessary at some time in the future. Known as arthroplasty, the procedure involves extensive surgery to remove any affected sections of bone and replace them with suitable prostheses. Once again, the financial support needed to meet the cost of the prostheses is likely to be available only with products offering more comprehensive medical aid cover.

However, one of the main difficulties facing a prospective member when attempting to choose the most appropriate product is that the applicable terms and conditions are often difficult to understand. The role of a fund is complex and, given that it must operate as a not-for-profit company, it is vital for it to create a sound balance between premium income and claim payments, and this is achieved through the careful design of benefits and strict T&Cs. Understanding both will be crucial to your choice and in determining whether your medical aid cover is sufficiently comprehensive.

In its desire to ensure its members fully understand the benefits provided by its various products, KeyHealth has adopted a policy of explaining everything in simple, everyday language. Each benefit is described in detail, indicating the maximum amounts claimable, where applicable, and in a manner that makes it quick and easy to compare the relevance of each of its six products. These range from the entry-level “Essence” and “Origin” products to the comprehensive medical aid cover of its “Platinum” product.