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Medical Aid – Comprehensive Medical Aid Cover is Vital


Comprehensive Medical Aid Cover is Vital for Most South Africans

With the exception of the very wealthy and those who may be lucky enough to enjoy perfect health, the need for some form of financial assistance in order for most South Africans to cope with the rising costs of healthcare has now become crucial. Even for the young and healthy, the risk of an accident or an acute episode of appendicitis that could call for emergency surgery threatens a possible financial disaster, unless they are a member of some suitable insurance scheme.

Of the various alternatives, the type of comprehensive medical aid cover that is offered by one of the country’s one hundred or so registered schemes is certain to be the best option. Unfortunately, the same rising costs that have led to the steady decline of the once exemplary state-funded healthcare services have also hit the private sector. This has seen consultation, accommodation and treatment costs rise to new heights that must be recovered from their patients’ accounts.

Such bills are well beyond the capacity of the average South African to meet unassisted, leaving most with no choice other than to join a scheme or turn to the ailing state healthcare facilities for their treatment, and perhaps be faced with the excessively lengthy waiting lists that, in recent years, have become the norm.

Statistics confirm that as much as 95% of the revenue currently earned by the private hospitals, specialists and related services, such as pathology, radiology and the like, is paid, not by their patients, but by their patient’s medical aid schemes. Without access to reasonably comprehensive cover, the vast majority of those treated would simply be unable to afford South Africa’s private healthcare facilities.

Given the slow economic recovery and the related fall in employment, affordability has become a major issue among those in need of this type of financial support. As with any insurance, the monthly premiums tend to reflect the value of the benefits on offer. To help minimise the former without sacrificing the latter, schemes have needed to adopt some innovative measures. Of these, the hospital plan has proved to be a valuable resource and, apart from the more limited hospital cash plans offered by insurance companies, it is also the most affordable option. It is, however, unsuitable for families, being aimed primarily at young, single people of sound health who only require financial help in the event of an accident or medical emergency.

To operate effectively, a medical aid scheme must have sufficient membership and while many may offer comprehensive cover, the so-called freebies that are often used to encourage enrolment definitely add Rands but no core value to the premiums. Since all schemes are now legally required to offer certain prescribed minimum benefits, including all expenses arising from any of 25 chronic illnesses, the main differentiator lies in the type and extent of the other benefits.

In this respect, discounted gym memberships and movie tickets offer little of real value when compared with the totally free, core additions provided with all of our KeyHealth products. By contrast, our scheme’s Smart Baby and Easy-ER programmes are standard offerings that entail no extra cost, but that are relevant and valuable additions to our medical aid products, offering affordable membership, yet providing exceptionally comprehensive cover.