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10 Questions to Ask During a Medical Aid Comparison


Conducting a medical aid comparison online is relatively easy. However, it is essential to consider the factors discussed here before making your decision. If you work for a company that offers membership in a group scheme, your only concern will be to select which of its products will best meet your needs. Furthermore, your employer will contribute to your monthly premium. Although you are not compelled to join that scheme, your company will be unlikely to offer the subsidy if you choose to enrol in another.

Today only 18 schemes are open to everyone and are the only options for the self-employed. Visit a comparison site, type your personal details into an online form and watch your email inbox for quotes. Next, ask the following questions:

  1. How much is the premium?

Money is tight at the moment, and most South Africans need to watch their spending. Understandably, you must choose a product you can afford but don’t just pick the cheapest. Select all that fall within your budget to continue your medical aid comparison.

  1. Can you choose your service providers?

Most medical aid schemes operate a network of designated providers to secure more favourable rates. If you have a personal preference for a particular clinic or surgery, you could risk qualifying for less support when submitting claims. You may need to contact each scheme to see if they deal with your preferred provider or accept their choices.

  1. Are the benefits relevant?

What you will get for your money should be your foremost concern. Based on your health history and your family’s, you should select only those products that adequately cover your likely needs and any unexpected medical emergencies. For example, look for options like orthodontics cover if you have young children. If someone has a pre-existing condition, will it be covered? If you are young and enjoy good general health but are on a low income, a hospital plan could be your best bet.

The remaining points refer to the specific terms and conditions that apply to each product. It is vital to study these carefully when making your medical aid comparison.

  1. What waiting periods apply?

If you have been a member of another scheme within three months of your application, your cover will start immediately. However, first-time members will face a compulsory three-month waiting period before their claims will be accepted. Members with pre-existing conditions cannot make related claims for 12 months except those with a life-threatening emergency or a chronic illness included as a prescribed minimum benefit.

  1. What prescribed minimum benefits apply?

The Council for Medical Schemes lists contingencies companies must cover with all their products. The list names 26 chronic illnesses, and cover must include diagnosis, treatment and care. Don’t despair if your condition is not mentioned. KeyHealth’s Equilibrium members are covered for 29 chronic diseases, and our Gold members are covered for 44. You’ll find nothing to beat that in your medical aid comparison.

  1. What limits apply?

Each scheme applies limits to individual claims and annual totals for each contingency covered. Beware of those that offer 100% compensation, as this is based on the fees recommended by the Department of Health, while private healthcare providers are free to charge what they like. By contrast, some schemes offer 200 to 300%.

  1. Are there any exclusions?

Only with fully comprehensive products is cover likely to be all-inclusive. For example, dental benefits may apply only to routine dentistry and exclude specialised work. Similar constraints may apply to other types of treatment, so check such details carefully as with all aspects of your medical aid comparison.

  1. What about co-payments?

Schemes that employ a network of designated service providers frequently undertake to meet most, if not all, of their members’ claims in full. Should you, for any reason, use an unauthorised provider, you will likely need to contribute a part of the cost. Make sure the scheme’s network operates in your area.

  1. Are there any add-ons?

Some schemes offer incentives to boost recruitment. Ignore shopping discounts and free movies; focus on free core benefits instead. KeyHealth’s products all include the Health Booster, Smart Baby Programme, and Easy-ER at no cost.

  1. Which scheme can I trust? You can rely on KeyHealth

KeyHealth is a trusted 55-year veteran with an enviable international credit rating, an above-average solvency ratio and a record of settling claims fairly and timeously. There’s no need for a medical aid comparison if you rely on KeyHealth! To protect your family’s health, follow this link to explore our 2023 products.