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Medical Aid Comparison – Meaningful Medical Aid Comparison


How to Ensure you Make a Meaningful Medical Aid Comparison

Given that twenty-five medical aid schemes operate locally, making a comparison before committing to one of them makes sense. Given that each of these organisations is competing for your business and a larger market share, the pressure is on to devise new and more ways in which to attract members. You may, for instance, be offered cut-price movie tickets or concessionary rates at your local gym. In some cases, members may qualify for discounts at a variety of retail outlets. While each of these may appeal sufficiently to sway your decision, none of them will help you to meet the costs of a hysterectomy or a triple bypass.

Medical aid funds, however, need no comparison in one respect. In South Africa, all of them are required by law to operate as non-profit companies. This, of course, means that somebody has to pay for those apparent freebies. Since it can only be paid from the premium payments collected from the scheme’s members, it is ultimately the member who pays and this must ultimately be compensated for in some way. Either benefits must be trimmed or the cost of these bonuses recovered by a higher monthly premium.

So, if one should not be too quick to make decisions based upon non-core benefits when choosing a medical aid, is it sufficient to make a comparison of premiums instead? The answer is both yes and no. If you are absolutely certain that the two competitors are both reputable, that the benefits they offer are essentially identical, that the product meets your needs and those of your family then, by all means choose the cheaper one. However, comparing benefits is not always as simple as it should be, and it is often all too easy to be misled by jargon and by conditions hidden in the small print.

In 1988, the South African government introduced a list of contingencies for which medical aid schemes must provide mandatory cover. No comparison of these prescribed medical benefits (PMB), which include all of the expenses involved in the treatment of twenty-five common chronic illnesses, such as diabetes, epilepsy, hypertension and rheumatoid arthritis, will therefore be required.

It is those benefits that are not mandatory, for which there is a need to look more closely at what individual schemes may be offering. The things to look for are limits. Each specific treatment or procedure, for example an appendectomy, is carefully costed and the fund will decide to what extent its cost will be covered. In some cases, a medical aid will cover the full cost, while a comparison may reveal that another only pays 90%. Both treatment and annual limits may be applicable with the latter for items like dentistry or optometry, often set relatively low and maybe not even covered by some products.

Clearly there is much more to choosing the right type of cover for you and your family than comparing the premiums, and the task is rarely a simple one. Aware of such difficulties and the importance of adequate but affordable cover, KeyHealth has focused on keeping things simple. Our WYSIWYG approach makes benefits clear, while our Easy-ER, Smart Baby and Health Booster programmes are both relevant and free, making KeyHealth a medical aid beyond comparison.