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Medical Aids – Medical Aids in South Africa


Basic Information on Medical Aids in South Africa

The medical aids in South Africa are governed by the Medical Schemes Act of 1998 and are all non-profit organisations where members make monthly contributions in return for the schemes paying for the medical services and products. This helps the members to afford treatments, hospitalisation, surgery, tests and medicine which would otherwise be unaffordable since the members would have to pay upfront for the services or products.


How to Select a Medical Scheme


Evaluate your health and the health of your dependants in addition to your family history of health and also consider what monthly amount you can afford. Will you in the near future require extensive medical care and how often do you need to visit a doctor? Do you or any of your dependants suffer from a chronic condition for which long term medical aid will be beneficial?


Types of Cover


You normally have the choice of a comprehensive medical aid that includes a benefits plan covering in-hospital treatments, out-of-hospital care and day-to-day costs. You also have straightforward hospital plans where only in-hospital stay and treatments are covered while you are responsible for the costs of any normal doctor visits and medicine purchases. Some hospital plans include savings accounts from which you pay for your day-to-day medical costs. Note that the law allows for a maximum of 25% of your total annual contribution to be allocated to a medical aid savings account. You cannot request cash-back bonuses for not claiming.


There are several medical aids in South Africa. Choose one that has a solid history, large enough member base and offers various free add-on benefits. Review the claiming process, the way the medical aid communicates with members, and how fast the scheme normally pays the service providers.


How to Get More from Your Medical Aid

Your medical scheme will have a Designated Service Provider (DSP) network. Though many doctors today ask far more than the medical scheme tariffs you can still find doctors that charge within the allowed range. Support the DSP doctors, unless you are willing to pay the additional costs that others charge. Where possible, request generic versions of patented medicine as these normally cost less than the patented versions, which will help you to minimise the risk of depleting your day-to-day benefits. If you are unsure that your scheme will pay for generic medicine, contact them to get a list of medicine that they will cover.


Make use of the free add-on services such as the ones offered by KeyHealth. This will help you to save on the costs of vaccinations, immunisations, ER services for your children and the costs of baby goods when you are pregnant. You will also save on the cost of a dietician or weight loss consultant and tests.


KeyHealth has an extensive network of DSPs to select from and provides various benefits packages to suit your particular budget and health requirements. We pay service providers directly and have an excellent reputation regarding payment.


Where a service provider requires you to pay upfront you will be delighted with our fast and easy claiming process. You have full access to your claims records, details and other important information which helps you to manage your medical spending from wherever you are. We offer several communication channels ranging from SMS to online chat, email, telephonically, fax, and personal. In addition, we keep you up to date regarding our services and tips for keeping healthy through our newsletters and website.


We adhere to the principles of ethical conduct and thus keep your records confidential. Our approach to medical cover is to provide our members with maximum benefit for their contributions and we review our price structuring annually to ensure affordability for all our members. Contact us today for more information about our benefits plans and our claiming processes.