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How to Find the Most Suitable South African Medical Aid


While most of us tend to take our health for granted until it fails us, the pandemic has taught us that even the healthiest among us can be vulnerable to the unexpected. This stark reminder of human frailty also led many of the nation’s uninsured citizens to re-appraise the value of enrolling in one of the South African medical aid schemes. It also posed a question. Which of these schemes is likely to best meet your needs?

Unless you plan to join a company that participates in a group scheme and will be required to join it, your only choice is to investigate some of the 18 schemes open to the public and currently operating in this country. If like so many people in 2022, you are now operating on a limited budget, it might be tempting to simply look for the cheapest option and sign up. You would, however, be wiser to look more closely at what any South African medical aid scheme you may select is offering for your hard-earned cash. It is usually safe to say that you only get what you pay for, so a low premium price tends to suggest correspondingly less cover. Fortunately, there are exceptions. One option that offers members good value for money during the current financial difficulties is the hospital plan.


Hospital Plans as Cost-Efficient Cover

Hospital plans are not necessarily a viable choice for everyone. However, younger, single members with limited income are likely to find this option a lifesaver. Ostensibly, these products now offered by all South African medical aid schemes only assist with private healthcare expenses while the member is undergoing treatment as an in-patient. At all other times, the member must personally settle any outpatient medical bills, such as fees for GP visits and prescription charges.

That said, some schemes have gone the extra mile and can now offer affordable hospital plans that include some valuable day-to-day benefits. In addition, the Council for Medical Schemes (CMS) also stipulates that all of a scheme’s products must include certain prescribed minimum benefits (PMB). Consequently, among other things, all South African medical aid products, including hospital plans, must cover the cost of diagnosis, treatment and care of 26 named chronic illnesses. These include asthma, diabetes, epilepsy, hypertension, Parkinson’s disease and multiple sclerosis. PMBs and other additions extend the value of the hospital plan, opening this option to many who might otherwise be obliged to purchase more comprehensive and correspondingly costlier products.


How to Find the Best Cover for Your Needs

Nevertheless, comprehensive year-round cover is frequently essential for some families, especially if they include young children. Anyone choosing this option will need to look closely at the benefits of several South African medical aid schemes’ products before finalising their decision. With the help of a suitable comparison website, much of the weeding out process can now be performed online. The best plan is to begin by requesting multiple quotes and selecting all of those you are confident you can afford for closer examination. Once you have eliminated affordability issues, the next step is to evaluate the benefits and their relevance to your family’s known and anticipated needs.

For example, if you have young children, it might be a good idea to ensure adequate cover for dental work, particularly orthodontics. Choose a South African medical aid product with adequate maternity and paediatric cover if you are thinking about starting a family. However, checking the benefits included is one thing – understanding the implications is another. You may be impressed by a promise of 100% cover for certain contingencies. However, this means 100% of the tariff recommended by the Department of Health, while individual doctors and clinics are free to charge far more if they so choose. You should instead look for products that offer 200% or 300% cover if possible.

Alternatively, some South African medical aid schemes employ a network of preferred service providers and can offer full cover for those members who agree to use their services. While still free to choose alternative providers, members of these schemes may find themselves liable for co-payments.


KeyHealth has an Option for You

This system is favoured by KeyHealth, the nation’s oldest medical aid scheme, serving members since 1968. With a choice of six products, each with unique free core benefits, there’s little need to look further. We invite you to explore the offerings from one of the most respected South African medical aid schemes.