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Medical Aid – How much is Medical Aid in South Africa?


How much is Medical Aid costing Members in South Africa?

Even though they may be well aware of the need for some form of healthcare insurance, concerns about just how much is required to obtain reliable medical aid in South Africa remains a critical issue to many of the country’s less affluent citizens. The sad reality is that, in many cases, it can still cost too much for some to even consider investing in what, for most people, has now become the only means by which to cope with the steadily rising cost of protecting their health.

Under the circumstances that now prevail, those who may lack either the necessary funds or suitable insurance cover sufficient to meet the expense of private treatment have no option but to rely solely upon the facilities of the state-funded healthcare service. Desperately overworked and plagued by insufficient funding, many of the government subsidised hospitals have assumed the role of community clinics and can no longer offer patients more than primary care. In parallel, waiting lists for essential surgical procedures at the larger establishments have reached alarming proportions and are continuing to grow.

Aware that how much the premiums cost is now a major concern for those who are seeking medical aid in South Africa, fund managers have been forced to come up with various solutions that allow them to keep these at a minimum. The task is not an easy one and is certainly not helped by the fact that healthcare costs continue to escalate. These increases have been driven, to a large extent, by advances in technology, such as computer-aided tomography and nuclear magnetic resonance scans that have now become such valuable diagnostic tools. Adding further to their costs, the country’s funds have, since 1998, been required by law to fully cover the costs entailed in the treatment of 25 chronic diseases and a host of procedures defined as prescribed minimum benefits or PMBs. In addition, the law also requires them to operate as non-profit companies.

So just how much is it possible for medical aid funds in South Africa to do in their attempts to control premium prices? In fact, there appears to be a number of options, and funds tend to differ in the particular approach that they have chosen. The simplest solution is, of course, to offer less cover, and this is a strategy that may be applied in a variety of ways. For instance, certain contingencies may be excluded altogether, while others may have their individual and/or annual limits reduced. Alternatively, the percentage of each claim left to the claimant’s account may be increased.

One solution that has worked well for young people of sound general health but limited income is the hospital plan. This is a product that offers the member fully-comprehensive cover, but that is only valid during those periods when he or she is receiving treatment as an in-patient. This too must include any costs arising from PMBs, even though these may not be the primary reason for the patient’s admission.

Some funds focus on core benefits, without the incentives and loyalty bonuses favoured by rivals to swell their membership. At KeyHealth, that is our strategy and it underlines just how much an affordable medical aid in South Africa can offer its members.