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Medical Aid – Medical Aid that Works


Choosing a Medical Aid that will Work for You

Today, there are approximately ninety medical aid schemes in South Africa, so one might reasonably assume that finding one that can offer a product that works for you and your family should not pose much of a problem. Of this total, around two thirds are so-called closed schemes intended for group membership and created to serve only those employed by a specific company, within a given industry or who are members of a particular professional body.

Often, membership of a group scheme is a mandatory condition of employment and although members benefit from competitive premiums in exchange for this commitment, this can also have a downside. In the event that a relatively small number of members may make substantial claims, the premiums for all members, whether claimants or not, could be increased to compensate. Generally, however, the partial contributions made by the employer tend to buffer such increases.

For the individual who is self-employed or whose employer is not affiliated to a group scheme, finding a medical aid product that works for him or her is a task that will need to be tackled with care. It will also require some understanding of how a private healthcare insurer operates.

Like all insurance, healthcare cover depends upon the principle known as “shared risk”. Simply put, this means that because the majority of members are likely to make small claims or none at all, the total cash raised from premiums should be more than sufficient to meet any large claims made by the minority. However, the accuracy of statistics increases over time so, in any given year, such an assumption may not hold true. To cater for this eventuality, the insurer must maintain an adequate cash reserve. Calculated as a percentage of total income, it is known as the solvency ratio and its minimum recommended value is 25%.

Unfortunately, many medical aid schemes in South Africa maintain solvency ratios that fall far short of this recommendation, so to ensure finding one that works when the time comes to pay your claim, you will need to focus on its performance record. In addition to maintaining an adequate solvency ratio, a sound international credit rating and a large membership are further indicators of a scheme’s ability to meet your claims under all circumstances. While such information falls within the public domain, it is not always easy to find. However, a history of long service within the industry can normally be taken as a reliable sign of good governance and a satisfied membership.

KeyHealth began servicing South Africans in the late ‘60s and has used the experience gained over close to half a century to develop the type of medical aid that is guaranteed to work for you and for those who may depend upon you. Our focus is on transparency. Ehen you purchase KeyHealth products, what you see is precisely what you get, which is real, health-related benefits, explained in detail and in simple language.

Given an excellent credit rating and above-average solvency ratio, if our record of prompt claim payments alone fails to convince you, then a range of affordable products that includes several unique, valuable yet free additional benefits should definitely identify us as a medical aid scheme that works.