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What is a Medical Aid Scheme and is It Necessary?


We live in a world where we have the necessary skills, knowledge, and technology to address health issues and combat diseases and other threats to our wellbeing better than ever before. Since our health is one of our most prized features and directly determines the quality of our lives in so many ways, this is absolutely great news. However, as with most anything, healthcare also costs money. Money is, unfortunately, not accessible to everyone in equal measures, which complicates access to proper quality healthcare for a large percentage of the population. Medical aid schemes exist to address this barrier to access healthcare by making it more affordable for the general population.


What is a Medical Aid Scheme?

Medical aid cover refers to the actual cover one gets for medical costs. A medical aid scheme is an organisation or entity that operates a specific set of medical aid cover plans. According to the law in South Africa, a medical aid scheme must be a non-profit organisation. This means that they cannot have shareholders that they pay dividends to and that the income of the scheme can only come from member contributions and the returns on strategic investments.

By law, a medical aid scheme must be governed by a board of trustees and must be registered with the Council for Medical Schemes in order to be allowed to operate.


What is the Function of a Medical Aid Scheme?

Medical aid schemes typically exist with one main function in mind: to provide cover plans to help people pay for their healthcare needs. These can include everything from doctor’s visits to hospital accommodation, surgery, nursing, dental work, and other medical-related expenses.

For the majority of people in South Africa, these healthcare-related services would be out of reach financially without the existence of medical aid schemes, especially services rendered by the private healthcare sector. While a state-run healthcare system does exist, it often falls short in terms of funding, accessibility, and infrastructure to provide the levels of healthcare necessary to support the nation as a whole.


What’s the Difference Between Medical Aid Scheme Cover and Health Insurance?

Very often, people use the phrases “medical aid” and “health insurance” interchangeably to refer to the same thing. While it’s true that both of these phrases refer to financial support in terms of accessing healthcare, there is an important difference.

Medical scheme benefits are governed by the Medical Scheme Act, while health insurance products often fall outside these regulations. The Medical Scheme Act, for example, requires medical schemes by law to provide health cover in accordance with the Prescribed Minimum Benefits (PMBs) for 270 life-threatening conditions and 26 chronic conditions. These include emergencies and chronic conditions such as diabetes, asthma, epilepsy, coronary artery disease, hypertension, and more.

Health insurance, on the other hand, typically provides cover for contingency expenses that are associated with events related to healthcare. This could include things such as covering a loss of income, hospital gap cover payments, hospital cash plans and medical travel insurance. While this service certainly plays an important role to some, it does not provide for basic healthcare and could leave you out of pocket regarding day-to-day medical expenses.


The Perceived Barrier to Joining A Medical Aid Scheme

With the benefit of covering a person’s essential ad day-to-day medical expenses, it would make sense that everyone would be lining up to claim membership to a medical aid scheme. However, the monthly premiums for a medical aid plan can be very costly for some, especially when an immediate need is not evident. This cost, which is then perceived as unnecessary when planning a budget, is often the main barrier for most to join a medical aid scheme plan.

This is not necessarily the best plan of action but is understandable. The cost can seem unnecessary to those who are generally healthy, young and with a smaller budget to work with. However, more affordable options do exist to help members meet basic healthcare needs and should be considered by everyone with the means to join.


The Risk of NOT Belonging to a Medical Aid Scheme

When one is young or healthy, medical expenses do not seem like such a huge burden. Doctor’s visits are typically few and far between, and relatively affordable once in a while. However, the risk increases exponentially when one has a chronic illness to manage, or when an accident or emergency happens, and one needs hospitalisation and extended medical care.

The medical expenses related to this type of healthcare can literally add up to hundreds of thousands of rands. Without the protection offered by a medical aid scheme, a patient is either left without the necessary medical care or could be financially depleted (or even ruined). This might seem like doom and gloom scaremongering, but it’s, unfortunately, a very real risk that we all face and need to be prepared for.

However, before you join just any medical aid scheme…

Even though medical aid schemes are regulated by the Medical Scheme Act, it doesn’t mean that they all offer the same benefits and level of cover. You cannot base your choice on signing up to the first plan you find that you can afford. It’s vital to do your research and compare your options to find the best choice to meet your needs.

How to select the right medical aid option

  1. Start by identifying how much you can afford a month – some cover is better than none, and there is no point in signing up for a plan that you cannot afford
  2. Be honest about your medical needs that need to be met, as different plans are designed to meet different healthcare usage needs
  3. Also consider the needs of your family or dependents, if they are to be added to your plan
  4. Research and compare available plans to see which option meets your needs best while fitting into your budget
  5. Ask questions until you understand what the benefits, terms and conditions of a plan mean, as industry jargon can often be confusing or daunting


The KeyHealth Solution

Choosing a medical scheme is almost always a complicated task. Medical jargon, a wide variety of schemes, and an even wider range of benefit options can make it extremely difficult to find the right fit for you. KeyHealth Medical Scheme is one exception – we strive to keep things simple and make plan comparisons easy based on your needs. Compare our products today to see why we’re the ideal medical aid scheme to look after your healthcare needs.