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What Are the Current Medical Aid Options in South Africa?


Strictly speaking, the medical aid options in South Africa are those available from non-profit organisations dedicated to this purpose, who are overseen by the regulatory body formed in 1998, known as the Council for Medical Schemes (CMS). There is, however, an alternative means to finance private healthcare expenses in the form of a product available from many of the nation’s long- and short-term insurers. Not too surprisingly, it is known as medical insurance, and since the industry has its own regulators, and any conditions mandated by the CMS do not apply to their products, insurance companies are under no obligation, for example, to provide cover for prescribed minimum benefits

Unlike the claims made for the various medical aid options in South Africa, the payments are not made directly to the relevant service providers, but to the insured individual who is then free to utilise them as they wish. More significantly, the sums paid are directly related to the agreed premium, and will generally be insufficient to cover more than a small portion of the actual cost of treatment. Typically, this type of cover tends to be used more to cover any incidental expenses arising from an illness or injury. It is often purchased in addition to the more comprehensive cover provided by a dedicated scheme, perhaps to cover co-payments by the member when these might apply.

Genuine medical aid options in South Africa are more about the various products offered by individual schemes. Each product will have its own particular set of benefits, and the extent will be determined by the premium price. For some contingencies, there may be no limit to the number of times a member may claim, or the value of such claims, whilst others may be subject to a cap on the frequency and/or value of individual and/or cumulative claims. Membership of a scheme is valid for 12 months, at which time a new contract must be signed.

It is not just the benefits and the premiums applicable to the various medical aid options in South Africa that may differ, however. The schemes fall into one of two categories, and may either be open or closed, and more than two thirds currently fall into the latter category. These are group schemes that offer preferred premiums exclusively to those who, for example, are employees of a participating company, organisation, or institution, employed within an industry, such as mining, or who may be members of a particular professional body. In addition to enjoying discounted premiums, employees will often receive a contribution to those premiums from the employer as part of their agreed remuneration package.

As for the open schemes, membership is available to anyone, but, of the two main medical aid options in South Africa, these are aimed at the needs of those who are either self-employed, or whose company may have simply chosen not to participate in a group scheme, or is insufficiently large to qualify for entry into such a scheme. Among the nation’s most innovative open schemes is that operated by industry veteran, KeyHealth. Our company offers comprehensive cover that includes several unique core benefits, for premiums that few competing schemes can match.