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Helpful Guidelines for Those Looking for Medical Schemes


Due to the steady decline of the national health service, many South Africans must now depend on medical schemes to help fund their private healthcare needs. Medical aid is not a new idea. Our earliest known example dates back to 1899 when the mining giant De Beers established a scheme for its workers. Other companies followed suit, and by 1939, there were 48.

Later, dedicated organisations were established for this purpose, and in their heyday, almost 300 schemes were operating. However, that meant many businesses were competing for a slice of a limited-sized cake. Some became insolvent, while others merged to boost membership numbers and cut costs. Today, just 76 of those medical schemes, of which only 18 are unrestricted and willing to accept applications from the general public, remain active.

To ensure making the right choice, an individual or family looking for medical aid in South Africa will need to focus on the following two main areas:

 Choosing a Suitable Scheme

Service providers differ; some have proved more dependable than others. Here are a few criteria that will help you to make the best choice.

  • Longevity is a reliable measure of a company’s performance and, by extension, the quality of its services and the extent of its customers’ trust in those services. While some are comparative newcomers, KeyHealth has been helping to finance South Africans’ private healthcare expenses for over 55 years.
  • Word-of-mouth recommendations based on the positive personal experiences of close friends or family are good guides, and one may be more inclined to trust these than rely on glowing reviews of medical schemes from unverifiable sources.
  • Compliance with the critical requirements set by the Council for Medical Schemes (CMS) adds an official stamp of approval to the above criteria. Meeting those requirements is especially important as medical aid schemes are not-for-profit organisations. The CMS requires all schemes to maintain a solvency ratio (cash reserve) equal to at least 25% of its annual premium income.

Furthermore, because events like the COVID-19 pandemic can create exceptionally high claims volumes that could exhaust cash reserves, medical aid providers must also maintain a sound international credit rating. Details of these criteria are open to public scrutiny and can usually be found on a scheme’s annual report.


Selecting the Right Product

Medical schemes offer several products to ensure appropriate and affordable support for as many members as possible. A typical product portfolio will include an entry-level hospital plan with no day-to-day benefits, a top-of-the-range product providing fully comprehensive cover for inpatient and outpatient medical expenses, and various intermediary products with progressively increasing benefits.

A few, like KeyHealth, offer additional core benefits at no charge. These should not be confused with marketing tactics like promising unrelated discounts to attract new members. Other factors that should guide your choice include:

  • Affordability: Your decision should never be based on price alone. Instead, you need to review all the options within your budget before committing.
  • Benefits: Although other factors like claim limits are significant, the benefits offered will do most to determine whether a given product will meet your needs and, where applicable, those of any dependent members. The best approach is to conduct an audit of your known and likely medical requirements and choose those products that will adequately satisfy them.

For example, parents of young children might want to check the orthodontic benefits, or if you’re planning to start a family, check the maternity benefits. The KeyHealth Smart Baby programme is free and an excellent option for new and expectant moms.

  • Pre-existing illness: A mandatory CMS directive requires medical schemes to include several prescribed minimum benefits in all of their products. These include cover for the diagnosis, treatment and ongoing care of 26 chronic conditions, such as asthma, bronchiectasis, Crohn’s disease, epilepsy and diabetes types 1 and 2.

However, you should be aware that, like any other pre-existing condition, these will not be paid for during the first 12 months of your membership. After that, they will be covered year-round, whether in a hospital or receiving treatment as an outpatient.


Why Choose KeyHealth Over Other Medical Schemes?

As one of South Africa’s most trusted and long-serving schemes, we go the extra mile to give our members peace of mind and more for their money. Why not click here to view our 2024 products and their three valuable free core benefits?