Medical Aid – How Do You Choose?

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In South Africa, citizens are lucky enough to have various options for medical aids from many different schemes. This can make it easier or harder to find the right one for your family. More choices mean you have to do extra research, but also allow you to choose a plan that meets your needs perfectly.

The question is – how do you choose a medical aid if you don’t know the first thing about the jargon used in the available packages?

 

How Do You Choose? Learn the Language

No one has time to become an expert in every field. However, there is a quick way to get the necessary knowledge for clarifying what is offered in a health insurance package. Find a guide for medical industry terms and keep it open in a separate tab while evaluating the cover options of different schemes or see the most common jargon used and their meanings below:

    1. Child Dependants (CD) – Persons younger than 21 that are also covered in your plan. The child does not have to be a blood relative and can be someone that you have adopted into your family by filling in the legal documents thereof. These dependants are usually charged at a lesser rate than adults.

 

    1. Chronic Conditions – These are terminal illnesses and conditions that exist in a person for a minimum of three months and need routine treatment for the patient to stay in a good state of health.

 

    1. Chronic Disease List – This is a set list of chronic conditions, of which the treatment must be covered in medical aid to adhere to the relevant legislation. There are currently 26 illness conditions included in this list, and it can sometimes be referred to as the CDL for short.

 

    1. Co-Payments – When a scheme expects its members to pay additional fees for certain procedures, above the amount that they cover for the specific treatment, it’s called a co-payment.

 

    1. Day-to-Day Benefits – A more inclusive package at a scheme typically includes day-to-day benefits, which are for treatments not done in hospitals. Look at the Equilibrium Option as an example of a package that offers some of these.

 

    1. Designated Service Providers – This is the network a scheme chooses to partner with, and where full cover typically applies. This network can also be referred to as DSPs, and members may be asked additional fees when not choosing to use one of the designated service providers of a scheme for non-emergency procedures.

 

    1. Emergency – A situation where the unexpected happens and urgent medical care is required to prevent long-term defects or death of the patient. At KeyHealth, we have a free additional benefit available in all our packages, called Easy ER, which relates to this term and allows members to make use of any hospital’s ER when a sudden health-related emergency occurs even if it is not a DSP.

 

    1. Exclusions – When you choose a medical aid, it’s crucial to see the exclusions to know which conditions are not covered in the plan. With our Origin option, you can see these on the right-hand side of the page under ‘Not Included’.

 

    1. Late Joiner Penalties – These are penalties that apply to new members who only join a scheme later in life, over a certain age. It can also be inflicted if you have not been part of a scheme for some time, even if you had medical aid before.

 

    1. Medical Savings Account – The MSA is a term that can be part of a cover package, as seen with our Gold option. This means that a portion of your monthly contribution goes towards an account to pay for day-to-day expenses. The fund can be carried over to the next year, depending on the scheme you choose.

 

    1. Pre-Existing Conditions – All illnesses, disabilities or other health-related matters that are already present when you sign with at a new scheme.

 

  1. Prescribed Minimum Benefits – These can be called PMBs for short, and are a group of benefits that all schemes have to cover, regardless of the option you select.

 

KeyHealth Cuts through the Jargon for You

These are only some of the terms used in the healthcare and health insurance industries. If the jargon is getting the better of you, don’t hesitate to contact us and we’ll make sense of it all for you. You can also join a scheme early to avoid late joiner penalties, and switch to another option later if you would prefer to opt for another package.

Medical aid – how do you choose? Pick KeyHealth and gain free additional benefits, along with transparent and helpful online support and inexpensive coverage options.

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