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Be Sure to Understand Your Medical Aid Quotes Before Joining


Around 9,5 million South Africans receive help with their private healthcare costs, but only understanding medical aid quotes will ensure adequate cover. For most minor purchases, obtaining detailed quotations and comparing them is usually unnecessary. However, if we choose to do so, more often than not, we tend to adopt the same policy as the average short-term insurer and settle for the cheapest.

Nevertheless, there are other instances where a closer comparison of quotations is essential before reaching a decision. For example, a new Toyota bakkie will retail for the same price wherever you buy it, but you will probably go with the one that offers you the best trade-in price for your older model. In short, the devil is in the details.

The same adage applies to medical aid. While how much you must pay is important, especially in the current financial climate, precisely what you can expect in return for your monthly premiums is actually far more so. In short, it could be a grave mistake to base your purchasing decision on the price tag without first examining the benefits, terms and conditions of your chosen medical aid product more closely.


Applying for medical aid quotes

The internet has dramatically simplified the process of obtaining quotations. In many cases, you are likely to be referred to a web address, even if you telephone your enquiry. In practice, when looking for accommodation, car insurance, airline tickets, or medical aid, you can usually find all or most of the information you need on the service provider’s website.

There are now several comparison sites where one can obtain multiple quotes with a single request. When entering a few personal details and outlining your needs, an algorithm will seek compatible products from several medical schemes and display them on screen or forward them to your email inbox.

Not all schemes are represented on a given site, so it could be worthwhile to try more than one. The more medical aid quotes you receive and examine, the more informed will be your final decision.


Analysing your medical aid quotes 

The first step in finalising your decision should be eliminating those offers you cannot afford. Next, you need to take a close look at the benefits. Ensure your known needs are covered and note any limits applied to claims. Before proceeding, you should know that all medical aid products are subject to terms and conditions, which may require some explanation. Of these, the most significant are the statutory waiting periods. There are two types, and their application may vary, so you should check the T&Cs carefully.

  • General waiting period:

Medical aid providers have a right to apply a three-month waiting period for new members who fail to meet their prerequisites. This restriction will apply to those joining a scheme for the first time and anyone not a member of another scheme during the three months before their application. Only claims arising after the general waiting period will be processed. If you plan to switch schemes, it’s best to do so promptly.

  • Waiting period for a pre-existing condition:

Members with a pre-existing illness at the time of joining will not be free to claim expenses arising from that condition for the first twelve months of their membership; this includes prescribed minimum benefits. However, claims for all other contingencies covered by a given medical aid product will be honoured from day one unless the general waiting period applies.

Medical schemes are non-profit companies subject to the terms set by their governing body. Unlike insurance companies, they may not refuse cover to applicants who represent a high risk or increase their premiums to compensate. There is, however, one exception to this policy.

  • The late joiner penalty:

Unfortunately, some individuals only start looking for medical aid quotes when they actually become ill. Because the risk of illness tends to increase with age, schemes may apply a penalty to first-time applicants aged 35 or older. Where relevant, applicants will be charged a higher monthly premium, and any applicable waiting period will also apply.


Choosing your provider

Reliability is crucial, regardless of any other promises in your medical aid quotes. KeyHealth has been helping South Africans with private healthcare expenses since 1968. We offer affordable products relevant to our members’ needs, including additional free core benefits. Why not contact us about a KeyHealth plan to protect your family’s health today?