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Medical Schemes South Africa | Medical Schemes | KeyHealth Medical Scheme


Advantages of Belonging to Medical Schemes in South Africa

Being a member of medical schemes in South Africa is viewed as being essential by many, in part because state hospitals and clinics are under pressure due to the sheer volume of people seeking medical attention and medication. The former simply don’t have the time or inclination to queue and wait to be seen.

Medical schemes in South Africa enable patients to consult the same GP every time and build up a good doctor/patient relationship, especially if children and the entire family are involved.

State health institutions, on the other hand, run out of prescription drugs periodically, according to press reports over the last few years, and vital diagnostic and treatment equipment breaks down because of frequent use, resulting in delays for ill patients when spare parts have to be imported to effect repairs.

This does not mean that the care of non-fund members at state hospitals and clinics is inferior. In fact, the opposite is often closer to the truth, particularly at training hospitals. However, that more personal doctor/patient relationship preferred by most medical aid members is not generally found anywhere other than in private practice.

The level of auxiliary services and amenities at private hospitals affords patients more choice. This includes the likes of being able to be in a private ward or to make a menu selection for their dinner. Also, you’ll be able to make an appointment to see your GP, dentist or ophthalmologist, arrive at the appointed time and are attended to shortly thereafter, in comparison to the state-run facilities where you have to sit and wait for your turn.

After a mutual discussion of your ailment and treatment, you’re issued with a prescription, which you have filled at your pharmacy and off you go. If you are taking chronic medication, your prescription indicates that it is to be repeated for a six month period, so you don’t need to see the doctor during the course of that six months, if nothing else goes wrong. What could be more convenient?

Some medical schemes in South Africa require patients to pay service providers upfront and then submit the claim and proof of payment for refunding. Most of the bigger concerns pay the supplier directly, less there is any levy or co-payment that might apply.

At state-run facilities, prescription drugs are supplied free of charge or at a minimal cost, depending on the recipient’s financial position. However, in many instances, the whole process has to be repeated monthly, whether you have to take time off work, or not.

Medical schemes, in their simplest form, are said to have their origin in South Africa in about 1889, only being formalised to some extent, under the Friendly Societies Act, (Act 25 of 1956). Later, in 1967, the first Medical Schemes Act (Act 72 of 1967) came into being.

It was only during the 1980’s when changes in regulation again took place, that the funds that we have today started evolving. More recently, it was legislated that all schemes have to offer prescribed minimum benefits (PMB’s). They have to pay for the conditions listed in the latest Act in full.

Most have a network of preferred service providers with whom they are contracted and apply a formulary list of drugs, which have generic equivalents of the original patents. Societies prefer beneficiaries to make use of these in both instances, in order to avoid co-payments.

All the major medical aids have a selection of plans, offering varying cover for different conditions and procedures, at different member contribution fees. This enables people to see exactly what benefits each option provides and what it would cost.

Many mid to large companies include membership of a medical aid as part of their remuneration package, normally arranged through a broker. The employer partially subsidises the employee’s monthly contribution.

In these times, our road accident toll is huge. Although much attention is given to these statistics during the main holiday periods, December and April, a similar situation prevails throughout the year. Our crime rate remains high, often resulting in severe injury to victims.

Quick response to an emergency situation is vital and this includes medical attention at the scene and thereafter. Even when hospitalisation is not necessary, trauma counselling and support may be essential in order for victims to make a full recovery. Thus, membership of a medical fund can sometimes mean the difference between life and death.

We are one of the open medical schemes in South Africa; anyone is free to apply and join our fund. Our goal is and always has been to provide quality services and affordable products to our valued members – you can be one of them.