There are currently 76 schemes operating in South Africa. Nevertheless, finding a medical aid that meets your needs is not always straightforward. The membership year begins on the first of January and ends on the 31st of December. Premiums are paid monthly and are subject to annual increases to cover rising costs. However, given the prevailing economic climate over the past few years, many people are now looking for cheaper options to cover the growing cost of private healthcare, while others have been forced to abandon membership in a scheme altogether and trust their health needs to the ailing state-funded system.
Most medical schemes try their best to cater to the needs of as many members as they can while attempting to keep premium prices as affordable as possible. However, they must also ensure their premium income is sufficient to meet their members’ claims. For the scheme managers, this can be a delicate balancing act.
Some medical aid schemes have attempted to address the affordability issue by reducing the maximum amounts a member is entitled to claim for selected contingencies. By adopting this practice, they are better positioned to keep their annual premium increases to a minimum. Often, those areas generally regarded as non-critical are targeted for cutbacks – for example, maternity benefits.
Get More, Not Less, with KeyHealth Medical Aid
Like our competitors, we strive to keep our premiums affordable. However, we also aim to ensure you receive as much as possible in exchange for your hard-earned cash. Maternity benefits are just one of many areas in which we have exceeded our members’ expectations.
However, a word of caution before we go into more detail about these benefits. If you join a medical scheme when you are already pregnant, all providers treat pregnancy as they would any other pre-existing condition, such as diabetes or asthma. Consequently, you will not be permitted to claim for the cost of any maternity-related service during your first 12 months as a member.
On the other hand, if you should fall pregnant during the membership year, you will qualify for whatever maternity and paediatric benefits are included as standard in whichever of your scheme’s products you decide to choose.
By contrast, we have a policy of going the extra mile. If you fall pregnant while you are a KeyHealth medical aid scheme member, you qualify for valuable additional help with aspects of your confinement that other companies don’t address. Furthermore, these added benefits are free of charge and come standard with all KeyHealth products, including Essence, our entry-level hospital plan. First-time moms, in particular, will find the KeyHealth Smart Baby Programme indispensable. Here is what you can look forward to:
- Around-the-clock access to Netcare 911: Members can dial 082 911 anytime for medical advice and information from Netcare’s Health-on-line services.
- The New Baby and Childcare Handbook: This publication by internationally renowned author Marina Petropulos provides first-time moms with everything they need to know.
- Antenatal visits: The programme entitles members to a total of 12 visits to a GP, gynaecologist or midwife, two ultrasound scans, plus dipstick urine tests.
- Paediatric visits: Newborns are entitled to two visits from a paediatrician during their first year of membership and an additional one the following year.
A natural birth in hospital costs around R25K, but a Caesarean could be over R40K. The Smart Baby Programme allocates additional sums for other maternity needs as follows:
- Antenatal vitamins: Members are granted R2 440 per pregnancy for this purpose.
- Antenatal classes: Members will only receive this benefit during their first pregnancy, but it is also worth R2 440.
- Other related expenses: Finally, the Smart Baby Programme allocates the sum of R1 440, which may be used to pay any additional medical costs or to purchase small items for the baby during her pregnancy.
The Art of Keeping Medical Aid Affordable
Although trimming core benefits is an option some schemes employ to keep premium increases to a minimum, this is not the policy at KeyHealth Medical. Neither do we offer unrelated incentives to sugar-coat the bitter taste of price hikes. Instead, we do everything possible to reduce private healthcare costs without compromising your cover.
One of our solutions has been to appoint a network of designated service providers who agree to more favourable tariffs for our medical aid members who utilise their services. If you’re looking for medical aid or are considering a change, why not click here to view our generous 2024 benefits?
