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Medical Aid Options – Understanding Medical Aid


Understanding the Various Medical Aid Options that are Available Today

Medical aid options have changed considerably over the years. In practice, the prime objective of the first wave of changes was to make them meet the cost of treatment more effectively. However, many of those changes that have become necessary in more recent times have had to focus instead on ensuring that monthly premiums levied by schemes remain sufficiently affordable to as many South Africans as possible.

As is most often the case, the quest for affordability can carry a cost of its own and, in this case, it has been important for schemes to ensure that they do not compromise member benefits too severely in order to keep their contributions down. One of the possible medical aid options, not unlike that applied to vehicle cover in which the insured agrees to pay a larger portion of any excess, is for schemes to reduce the percentage of the cost that they are prepared to bear for certain contingencies or even to omit those altogether. Perhaps the best example of this approach is to be found in the type of products that are generally referred to as hospital plans.

These should not be confused with the hospital cash plans offered by insurance companies and whose benefits are not calculated against the known costs of treatment, as in the case of similar medical aid options, but take the form of a fixed cash sum paid daily. The sum is determined by the value of the premium paid and invariably falls far short of actual treatment costs. This makes these cash plans more suitable as a means to safeguard against lost income or to manage any co-payments that may occur with more comprehensive cover.

By contrast, hospital plans offered by specialised private healthcare schemes are designed to meet all or most of the actual costs of treatment as pre-agreed by their managers and, despite this, their premiums are only a little higher. By design, this is one of the more limited medical aid options in that it only covers treatment during periods of hospitalisation and leaves the member to meet the remainder of his or her healthcare costs as an out-of-pocket expense throughout the year. For a young person of sound general health and limited income, however, it is a very practical choice.

In the case of families, where cover for a spouse and one or more children is likely to be required, a more comprehensive product that provides for orthodontics, pre-natal, post-natal and paediatric attention could be essential. Efforts to make these more affordable are evident in many of the medical aid options available today and range from covering proportional rather than total costs, to stipulating that members must make use of a scheme’s network of preferred service providers, such as specialists, clinics, laboratories and pharmacy chains, wherever these may be accessible to them.

Many of the schemes providing private healthcare cover today are of the closed variety and restrict membership to specific companies, professions or industries. However, open schemes are numerous and most now offer a choice of several products and thus careful comparisons are advisable. Many South Africans, however, are finding that no such comparison is needed when joining our KeyHealth scheme with our affordable yet exceptionally comprehensive medical aid options.