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Medical Aid Options Available to South Africans


Which Medical Aid Options Are Available to South Africans?

One of the main differences in the terms and conditions applied by medical aid funds and the options that they offer stems from whether they are of the closed or open type. In the former case, the fund is designed to meet the needs of a group in which those covered all work for the same company, are employed within a given industry such as mining, or are members of a particular professional body, such as the Institute of Chartered Accountants. Because group schemes guarantee the fund a captive source of members, they are generally able to offer more favourable premium rates. By contrast, open schemes are unrestricted and will accept any individual. Such schemes are ideal for the self-employed.

Within these two classes of medical aid, individual schemes offer alternative options in which the monthly premiums charged vary and tend to determine the extent of the cover provided. Once again, it is convenient to classify their products into two types – those that offer members continuous and comprehensive cover, and those that only provide cover during periods of hospitalisation. Whether benefits apply to all contingencies during the twelve-month membership period or only during a stay in hospital, all South African schemes are required, by law, to provide certain prescribed minimum benefits. Among other things, these include covering the costs arising from emergency medical conditions and from the diagnosis, treatment and care of a list of 25 chronic illnesses as defined by the Medical Schemes Act.

Faced with the constantly rising costs of private healthcare, medical aids have adopted differing options to minimise premium increases. Some have relied on non-core incentives to increase membership in order to spread the cost of claims, while others have simply cut back on benefits and/or lowered the maximum limits for claims.

By contrast, KeyHealth has chosen to adopt neither of these strategies. Instead, we have cut costs by appointing a network of service providers and designed affordable new products with extended core benefits that are more directly relevant to the needs of the average South African family.