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Keep This in Mind When You Compare South African Medical Aids


While we are all aware of the importance of having sufficient proper medical aid in this country, the events of the year to date has probably made us even more aware of the vital role it plays in our health and wellbeing, and many of us may be in a situation where we want to reconsider our options to make our cover of choice work even harder for us and suit our needs even better. This is important – as our life stages and circumstances change, it is essential to review and adjust your medical aid cover, as necessary.

That said, choosing a new medical aid and going through all of the related admin is usually not a job most of us get excited about. Add to that the fact that there are numerous medical aid options – each with a number of tiered offerings – available in South Africa, this task can seem more daunting than one would wish for.

Where do you start? And how do you know that you are making the right choice? You definitely don’t want to find out when it’s too late that your medical aid of choice does not cover a procedure or event that you need it for.

As with most things, this is a process that is best-approached step by step. It’s essential to remember that this is your choice, and you have the power to choose a plan that suits your needs and pocket. To help you evaluate and compare South African medical aids to find the one that suits you and your family best, keep the following in mind:

Set a Realistic Budget

It can be very tempting to stretch your budget just that bit further to try and cover the most expensive medical aid that you could possibly find. This is because there is a perception that the most expensive plan is always the best plan. Don’t be fooled by this. You don’t want to jeopardise the other aspects of your life only to afford the most expensive plan on offer. Draw up a monthly budget and see what you can realistically afford without having to cut other important expenses. Let this amount be a guide and start with the options that fall into this price category. This will already help to create a smaller pool of options that you need to compare, making the process more manageable.

Consider Your Unique Health Needs

Ultimately, you need a plan that meets your specific needs – not one that necessarily has all the bells and whistles. While you cannot always know what will happen in future, you do know what current ailments or conditions you might have, what your general health requirements or habits usually are, as well as what risks you possibly face. Make a list of these and then use this list to eliminate the medical aid plan options that don’t cover the basic requirements you have.

Finding Value for Your Money

Now that you know how much you can comfortably spend, and what you need to look out for in terms of coverage, you can start finding the medical aid plans that offer you the most value for your money. Note that this choice will differ from person to person (or family to family). Some plans might manage costs by limiting payouts related to certain expensive procedures, such as joint replacements, while still offering attractive day-to-day benefits. Instead of looking for the premium-priced plans, look for those that offer lower rates by featuring these types of exclusions of conditions that might not be priorities for you or your family.

Don’t Forget About Possible Co-Payments

In most cases, medical aid schemes don’t cover the full private rate of all specialists and procedures, but only the medical aid approved rate. This means that a portion of these rates will have to come out of your pocket. Make sure that you check and understand what is being covered and what isn’t, so that you can prepare financially if necessary, and so that you don’t end up with an unexpected surprise when you least need it.

Take Note of Annual Limits

Most medical aid schemes will also limit the amount they cover with regards to categories of treatment, specialist visits or hospital stays per year, either per member or per family. Look out for these limits on cover, and make sure that you are happy that it meets the needs for you and your family.

Look Out for the Potential Implications of Underwriting

This is especially important when you switch from one service provider to another, when you join a medical aid scheme for the first time (or haven’t been part of a scheme for an extended period of time), when you are of a certain age, or when you have pre-existing conditions. It’s important to understand how the underwriting works of the scheme you choose and to understand how this could impact your cover, especially if it leads to waiting periods during which you can’t claim for any or select conditions.

Always Study the Benefits Very Closely

We get it, it takes time and it’s not the most fun way to spend your day. But be patient and take the time needed to carefully go through all the benefits offered by a specific medical aid plan. Often medical aid fine print can be filled with jargon and difficult to understand, so make a point of asking questions until you fully comprehend the cover offered. It could mean the difference between being covered or not when you need it most.

At KeyHealth, we try to make the process of comparing and choosing a medical aid plan as easy as possible. We keep the process as simple as possible and avoid the overuse of jargon wherever possible. Furthermore, we guide you through the process of selecting the plan that is right for you by breaking the journey down into simple steps, starting with the features that are unique to you in order to find the medical scheme that is the perfect fit for you.

If you are getting ready to start comparing South African medical aids, why not start with KeyHealth? You might just find that the process is much shorter and simpler than you may have imagined.