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Understanding Medical Schemes: Regulations, Governance and Members’ Perspectives

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A medical scheme is a non-profit organisation that gathers contributions from its members and provides benefits covering specific medical expenses according to its regulations. These schemes must be registered with the Registrar of Medical Schemes and comply with the Medical Schemes Act. Key obligations under the Act include:

  1. Providing prescribed minimum benefits, covering medical emergencies and certain chronic conditions.
  2. Applying community rating, meaning all members pay the same contributions regardless of age, gender, or health status.
  3. Admitting all applicants (for open schemes) or all eligible members (for restricted schemes).
  4. Paying benefits as outlined in the scheme’s rules, which must be registered and approved by the Registrar.
  5. Maintaining reserves equal to 25% of the contribution income and retaining surpluses.
  6. Outsourcing claims administration to profit-making service providers.

Scheme governance entails having a board of trustees, with at least 50% elected from its members. They are responsible for protecting members’ interests, avoiding conflicts of interest, and ensuring impartiality. Trustees appoint a principal officer for day-to-day operations and oversee financial matters, including record-keeping and submission of financial statements to the regulatory authority.

 

What Keyhealth Members Have to Say

KeyHealth offers complete, no-nonsense medical aid, delivering Rand-for-Rand cover across six value-for-money options for people from all walks of life. Our mission revolves around the answering the question, “How can we offer our members more?”. We are committed to providing more comprehensive health cover for our members and their loved ones, more accessible healthcare whenever it is needed, and more clarity and accessibility in an ever-more complex world. Ultimately, we offer more for every cent spent on healthcare.

Our customers’ feedback is a testament to how well we are fulfilling our goal to give our members the best value for money and customer experience from a medical scheme. These are only some of the experiences that KeyHealth members have shared:

“Just a note to say thank you for your service. You have been a great help. You secured us a premium R1500 less than our previous medical aid on a plan with much better benefits. Well done and thank you.”

“Best medical aid ever, for me… been in and out of the hospital and never paid even a cent.”

“We are members of KeyHealth for a very long time. Never had any problems when keeping by the rules. Communication is very important. When you’re not sure about something, just ask them.”

 

‘Affordable’ Can Go Hand-in-hand with Quality and Service Excellence

KeyHealth provides affordable medical aid and healthcare management services in a transparent and client-centred manner. Our affordable but high-quality range of products suits a diverse market with each of our medical aid options tailored to the South African customer’s healthcare needs. From the Essence hospital plan which is an ideal entry-level product providing access to the most essential healthcare services to the fully comprehensive Platinum option that meets the needs of families and others, there is bound to be a product best suited to you.

For more information, contact KeyHealth today and get quality healthcare that suits your pocket.

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