Close this search box.

KeyHealth Member Information

Member Services

Electronic Communication

Medical Scheme – Benefits of Joining a Medical Scheme


The Main Benefits and Snags of Joining a Medical Scheme

Whether you love them or hate them, there is no doubt that that belonging to a medical scheme, and enjoying both its benefits and its snags, is a commitment that only a tiny number of South Africans are in a position to avoid. The payments that members receive in exchange for the monthly premiums they are required to pay is the only thing saving many of them from having to make a troubling choice. That choice is between meeting the overwhelming cost of private healthcare from their own pockets and taking a chance on the facilities of a state health service that is underfunded, overworked, and increasingly failing to cope.

According to the industry regulator, in 2014, the total number of people receiving this form of financial assistance to offset the expense of private healthcare was already close to 9 million and growing. For those who choose this option, what is to be gained when joining a medical scheme, and is there also a downside to membership?

The benefits of becoming a member are both general and specific in nature. One of the main general advantages is that, in the event of a sudden illness, members are protected from meeting most if not all of the invariably high costs of treatment. Furthermore, because that treatment comes from a well-funded and well-equipped private clinic, it is also of the highest standard and available immediately without the long delays when required, first to find some means to cover the cost, or to join the lengthy waiting list at a state hospital.

Yes, some people may find that there is a downside. Premiums can be quite steep for those on a tight budget and are usually subject to annual increases. In some cases, a given scheme may set a limit on the amount it agrees to contribute towards the cost of certain services. Thus, where a service provider’s charge may exceed that limit, the member is required to meet any outstanding balance with a co-payment. It is perhaps also worth noting that those who live in rural areas may not always find it quite as convenient as the city dwellers when they need to access private healthcare facilities – a small enough snag when compared with the potentially massive cost savings.

The main difference between medical scheme products lies in the range of specific benefits offered to a member. All are required to cover all costs relating to a list of prescribed minimum benefits (PMBs) mandated under Act 131 of the Medical Schemes Act. Beyond these requirements, each product lists the various additional contingencies and all related costs together with the limits placed individually and annually on those costs in each case. Typically, a given product will define the allowances that apply to specialties such as dentistry, obstetrics, orthopaedic surgery and day-to-day cover when out of hospital, itemising the allocation to individual procedures.

It is the extent of the various contingencies covered and the financial limits placed on the related costs that determine the benefits of one medical scheme compared to another. In any such comparison, KeyHealth is consistently seen as providing exceptional value for money, whichever one of our five innovative and competitively priced products may best suit your needs.