Medical Aids in South Africa – Understanding the Various Options
With regards to medical aids in South Africa, one overwhelming reality should never be overlooked. Without the financial support from these organisations, the vast majority of those who are now free to enjoy private healthcare could no longer afford to do so. Even more serious perhaps are the consequences of this to the state healthcare services. Without the alternative option of affordable private treatment, the already overburdened state-funded scheme would collapse entirely in the face of the additional demand on its budget and resources.
Given that private healthcare is vital but a great deal more expensive than public services, both insurance companies and medical aids in South Africa have been faced with the need to provide cover that is sufficiently comprehensive, yet still affordable to as many as possible. The quest for a solution to this dilemma has resulted in a number of possible options for those seeking to subsidise their healthcare expenses.
The earliest method employed to reduce the impact of the premium payments on members’ incomes, and which is still in use today, was the formation of group schemes. By agreeing that all of a given company’s employees would be enrolled with a given fund, its employer could obtain discounted premiums on behalf of his or her staff from many of the medical aids in South Africa.
In many cases, as a condition of employment, payment of the already reduced premium is then shared between the employer and the employee, making the cost of membership even more affordable. Such schemes are described as closed schemes since, of course, membership is restricted to the given company employees and their dependents. On a larger scale, members of certain professional bodies, such as chartered accountants or of industries such as mining, can also benefit from this type of selective group cover.
Of around one hundred medical aids now operating in South Africa, about a quarter are open schemes, meaning anyone who can pay the premium can become a member. It is the option that suits those who are self-employed, retired or whose company offers no group cover and premiums are determined largely according to age and medical history. Various combinations of benefits, maximum amounts payable for certain services and overall annual limits give rise to a wide range of products of varying affordability, from simple hospital plans that provide good cover but only when a member is hospitalised, to fully-comprehensive schemes that cover most contingencies more than adequately.
Hospital cover similar to that offered by medical aids in South Africa, is also available form some insurance companies. Better described as hospital cash plans, they pay the insured a fixed sum for each day spent in hospital but, at best, this is likely to cover no more than 10 percent of the actual cost and is best used as a means to cover loss of income and incidental expenses.
Assessing a scheme that is perfect for you and your family, can require extensive research and is not made any easier by unnecessarily complex benefit descriptions and confusing terms and conditions.
At KeyHealth, what you see is what you get. Easy to understand and with no hidden costs, but plenty of free extras, we offer the most affordable medical aid options in South Africa.