Overall, Medical Aid can be a confusing and overwhelming topic, but it’s one that’s incredibly important to understand. From understanding medical aid and choosing the right plan to access care, there are many components to consider.
In this article, we’ll take a closer look at:
- ✅ Which is the best medical aid in South Africa?
- ✅ What is the best affordable medical aid in South Africa?
- ✅ How much is full medical aid in South Africa?
- ✅ How do I apply for medical aid?
- ✅ Top 5 medical aid schemes in South Africa
- ✅ Top 10 medical aids in South Africa
and much, MUCH more!
10 Best Medical Aids in South Africa – a Comparison
|🔎 Provider||💶 Contribution (from)||💙 Avg. Customer Rating|
|🟥 Discovery Health||R1338 ZAR||4.9|
|🟧 Bonitas||R1307 ZAR||4.5|
|🟨 Momentum||R495 ZAR||4.5|
|🟩 FedHealth||R945 ZAR||4.3|
|🟦 MediHelp||R756 ZAR||3.5|
|🟪 Profmed||R2055 ZAR||3.5|
|🟥 BestMed||R1307 ZAR||3.5|
|🟧 Medshield||R1584 ZAR||3.5|
|🟨 KeyHealth||R1814 ZAR||3.2|
|🟩 Bankmed||R801 ZAR||3.4|
10 Best Medical Aids in South Africa (2023)
- ✅ Discovery Health – Overall, the Best Medical Aid in South Africa
- ✅ Bonitas – Non-profit South African Medical Aid Scheme
- ✅ Momentum – Offers Essential and Basic Plans
- ✅ Fedhealth – Best Comprehensive medical aid provider
- ✅ Medihelp – Offers Savings Account Options
- ✅ Profmed – Perfect choice for graduates and postgraduates of a specific profession
- ✅ Bestmed – Popular Hospital Plan Provider Offers 24/7 Emergency Support
- ✅ Medshield – 11 Medical Aid Plan Options
- ✅ KeyHealth – Traditional Medical Aid Options
- ✅ Bankmed – Budget-Friendly Medical Aid
Medical Aid – Definition
Medical Aid is a system of financing healthcare in which individuals pay a regular premium to a scheme or organization that covers their medical costs.
The Importance of Medical Aid in South Africa
The factors below indicate some of the reasons why Medical Aid is Important:
- ✅ With medical aid, individuals can access private healthcare facilities and medical professionals, which often have better facilities and shorter waiting times than public healthcare.
- ✅ Medical aid protects financially against the prohibitive cost of medical treatments, hospitalization, and medication.
- ✅ Private healthcare facilities and professionals are known for providing high-quality care, and medical aid allows individuals to access this quality care.
- ✅ Medical aid schemes offer specialized programs for managing chronic illnesses like diabetes, cancer, and HIV/AIDS, providing support and access to medication.
- ✅ Medical emergencies can happen anytime, and having medical aid gives individuals peace of mind, knowing they can access medical care when needed without worrying about the financial burden.
Medical aid contributions are tax-deductible, which can provide a significant financial benefit to individuals.
Main Types of Medical Aid in South Africa
Private or Restricted Medical Aid
Restricted or Private Medical Schemes are medical aid schemes only available to specific groups, such as employees of a particular company or members of a specific profession.
Here are some features of Restricted/Private Medical Schemes:
- ✅ Membership is restricted to a specific group of people.
- ✅ They often provide comprehensive benefits to their members.
- ✅ Premiums are usually negotiated by the employer or professional association, which can lead to lower costs for members.
- ✅ Benefits and premiums may differ from those of Open Medical Schemes.
Furthermore, here are 5 examples of Private/Restricted Medical Schemes in South Africa:
- ✅ Profmed is restricted to graduates and postgraduates of certain professions, such as accountants, engineers, lawyers, and their families.
- ✅ Sasolmed is restricted to employees of Sasol Limited and their dependents.
- ✅ Anglo Medical Scheme is restricted to employees of Anglo Americans and their dependents.
- ✅ Bankmed is restricted to employees of the banking industry and their dependents.
Finally, The Government Employees Medical Scheme (GEMS) is restricted to employees of the South African government, provincial governments, certain public entities, and their dependents.
Public Medical Aid
Open or Public Medical Schemes are medical aid schemes open to anyone wishing to become a member, regardless of their employer or industry. Here are some of their features:
- ✅ Members can join as individuals, families, or groups.
- ✅ They offer a range of benefit options, which vary in terms of the level of coverage provided and the cost of the premiums.
- ✅ Members can choose their healthcare providers, including hospitals, doctors, and specialists, subject to the scheme’s rules and limitations.
Furthermore, here are 5 examples of Open Medical Schemes in South Africa:
- ✅ Discovery Health Medical Scheme
- ✅ Bonitas Medical Fund
- ✅ Momentum Health
- ✅ Medihelp
- ✅ Fedhealth Medical Scheme
Public Medical Schemes typically have a wider geographical cover than restricted schemes, as they are not limited to specific regions or industries.
Hospital Plans are standalone medical plans that provide cover for in-hospital medical expenses but exclude cover for out-of-hospital expenses.
Here are some features of Hospital Plans in South Africa:
- ✅ Hospital Plans cover in-hospital expenses such as specialist consultations, surgical procedures, and hospital stays.
- ✅ They typically have lower monthly premiums than comprehensive medical aid plans.
- ✅ They have limited coverage for day-to-day medical expenses, such as visits to the GP or medication outside the hospital.
- ✅ Some Hospital Plans may offer additional benefits such as emergency medical evacuation or funeral cover.
Here are some examples of Hospital Plans in South Africa:
- ✅ Discovery Health KeyCare Hospital Plan
- ✅ Momentum Health Hospital Plan
- ✅ Bonitas Hospital Plan
- ✅ Medihelp Hospital Plan
- ✅ Genesis Hospital Plans
Hospital Plans may also have certain exclusions and waiting periods, meaning members may not have immediate access to certain benefits.
Common Medical Aid Plans Available in South Africa
Essential or Basic Plans
Basic medical aid plans are usually the most affordable and provide limited benefits. These plans cover in-hospital treatment, emergency services, basic dentistry, and chronic medication for certain conditions.
Here are examples of Basic or Essential Plans:
- ✅ Momentum Ingwe
- ✅ FlexiFED Savvy
- ✅ Suremed Health Shuttle
- ✅ Makoti Primary Option
Essential or basic plans are best suited for young and healthy individuals who are unlikely to need extensive medical care.
Hospital plans provide cover for in-hospital treatment and some day-to-day benefits. However, they exclude cover for out-of-hospital medical expenses like doctor’s visits, medication, and chronic illness.
Here are examples of Hospital Plans:
- ✅ Bonitas Hospital Standard
- ✅ Sizwe Hosmed Silver Hospital
- ✅ CompCare NETWORX
- ✅ Genesis MED-100
Hospital plans are more affordable than comprehensive plans. Therefore, they may be suitable for those in good health who want protection against unexpected hospital bills.
Comprehensive medical aid plans provide the most extensive coverage for both in-hospital and out-of-hospital medical expenses. In addition, they offer a broad range of benefits, including consultations with healthcare professionals, medication, and chronic illness.
Here are examples of Comprehensive Plans:
- ✅ Fedhealth Maxima EXEC
- ✅ Discovery Health Classic Comprehensive
- ✅ Bonitas BonComprehensive
- ✅ Sizwe Hosmed Titanium Executive
Comprehensive plans are the most expensive and suitable for those requiring regular medical care or pre-existing medical conditions.
Savings Account Plans
Savings account medical aid plans work like a bank account, where you deposit funds that can be used to cover your medical expenses. They usually have a high savings threshold; once it is reached, the plan covers your medical expenses.
Here are examples of Savings Account Plans:
- ✅ Medihelp MedSaver
- ✅ Medimed Medisave MAX
- ✅ Discovery Health Classic Saver
- ✅ Bonitas BonSave
These plans are best suited for those with elevated control over their healthcare spending and willing to set aside funds for future medical expenses.
Network and Income-based Plans
Network and income-based medical aid plans usually have lower premiums than others, but they have certain restrictions. For example, they may require you to use specific doctors or hospitals, and your coverage may be based on your income level.
Here are examples of Network and Income-based Plans:
- ✅ Bestmed Rhythm 1
- ✅ Bonitas BonCap
- ✅ Discovery KeyCare Series
- ✅ Fedhealth MyFED
These plans are best suited for those on a tight budget and willing to accept the limitations that come with them.
10 Best Medical Aids in South Africa in 2023
In South Africa, several independent companies and organizations annually review and rank medical aid in South Africa based on factors such as affordability, benefits, customer service, and overall value. These organizations include the following:
- ✅ The Independent Community Pharmacy Association (ICPA) ranks the top medical aids in South Africa based on customer feedback and satisfaction.
- ✅ The Alexander Forbes Health Medical Aid Survey ranks medical aid based on value for money, benefits, and financial stability.
- ✅ The GTC Healthcare Consulting and Insight Survey ranks medical aids based on value for money, benefits, and customer service.
These rankings can provide a starting point for individuals seeking a medical aid plan that suits their needs. According to these organizations and their rankings, the following are the best medical aids in South Africa for 2023:
- ✅ Discovery Health
- ✅ Bonitas Medical Fund
- ✅ Momentum Health
- ✅ Fedhealth
- ✅ Medihelp
- ✅ Profmed
- ✅ Bestmed
- ✅ Medshield
- ✅ Keyhealth
- ✅ Bankmed
Discovery Health is a popular medical aid scheme in South Africa with a range of comprehensive plans. Their plans include generous in-hospital cover, preventative care benefits, and access to their extensive network of healthcare providers.
Some of the unique features of Discovery Health include Discovery Vitality, Extended Oncology Benefits, the WELLTH Fund, Connected Care, Hospital at Home, Assisted Reproductive Therapy, and more.
Overall, Discovery Health is known for its innovative offerings and commitment to providing quality healthcare to its members.
Bonitas Medical Fund
Bonitas Medical Fund is a non-profit medical aid scheme operating in South Africa for over 30 years. Bonitas offers a range of plans, including BonCap, BonEssential, BonStart, BonSave, and more.
One of the standout features of Bonitas is its extended network of healthcare providers, which includes private and public hospitals. They also offer a range of value-added benefits, such as maternity programs, chronic medication management, and preventative care benefits.
Overall, Bonitas is committed to providing affordable healthcare to its members while maintaining lofty service standards.
Momentum Health is a medical aid scheme that offers a range of comprehensive plans, with options for in-hospital cover, chronic medication management, and preventative care benefits.
Their plans also include emergency medical services and evacuation benefits, making them a popular choice for members who require frequent travel. Momentum Health also offers various wellness programs, such as Multiply, which rewards members for leading a healthy lifestyle.
One of the unique features of Momentum Health is its HealthReturns program, which offers members a cashback reward for staying healthy and completing certain wellness activities.
Fedhealth is a medical aid scheme operating in South Africa for over 80 years. They offer a range of comprehensive plans, including the FlexiFED Savvy plan, FlexiFED 1 – 4, a comprehensive Maxima plan, and more.
Fedhealth is known for its generous chronic medication benefits, with cover for various conditions. They also offer various value-added benefits, such as maternity programs and preventative care benefits.
Fedhealth is committed to providing quality healthcare to its members while maintaining affordable premiums. They also offer a range of wellness programs, such as the Fedhealth Wellness program, which encourages healthy living through rewards for healthy behavior.
Medihelp is a South African medical aid offering various plans to suit different healthcare needs and budgets. The plans include MedPlus, MedPrime, MedSaver, MedVital, MedElect, and more.
Medihelp has a good reputation for excellent service delivery and benefits that cater to the needs of its members. Some benefits include preventative care, hospitalization coverage, chronic medication, and day-to-day benefits such as GP consultations, dentistry, and optometry.
Profmed is a restricted medical scheme available only to graduates and postgraduates of specific professions, including accountants, engineers, and architects. The medical scheme has a good reputation for providing comprehensive coverage and benefits that cater specifically to the needs of professionals.
Profmed offers ten different plan options that range from basic to comprehensive cover, including hospitalization benefits, chronic medication, and day-to-day benefits such as GP consultations, dentistry, and optometry.
Bestmed is one of the largest medical aid schemes in South Africa, with over 200,000 members. The scheme offers a range of plans to cater to different healthcare needs and budgets, including comprehensive plans, hospital plans, and savings plans.
Some benefits include preventative care, hospitalization coverage, chronic medication, and day-to-day benefits such as GP consultations, dentistry, and optometry. Bestmed also offers additional benefits such as emergency medical services and a loyalty rewards program for its members.
Medshield offers 11 medical aid plans (PemiumPlus, MediBonus, MediSaver, MediPlus Prime, and others) starting from R1,584 per month. Medshield offers 24/7 emergency support but does not offer native comprehensive gap coverage for any policy.
Medshield plans are affordable, easily accessible, and easy to understand.
Keyhealth is a South African medical aid scheme offering various plans to suit unique needs and budgets. Their plans include hospitals, traditional medical aid, and network plans. Keyhealth strongly emphasizes preventative care and offers various wellness programs to help members maintain good health.
They also have an app that allows members to manage their benefits and claims easily. They also offer a rewards program where members can earn points for healthy behaviors.
Bankmed is a medical aid scheme offering various plans to suit diverse needs and budgets. They partner with various healthcare providers and facilities to give members access to quality care.
Bankmed offers a variety of wellness programs to help members stay healthy, including a weight loss program, a smoking cessation program, and a stress management program.
They also have a dedicated mobile app that allows members to manage their benefits and claims easily and offers a rewards program where members can earn points for healthy behaviors. Furthermore, Bankmed is particularly popular among members working in the banking sector or with ties to the financial industry.
The Benefits of Medical Aid Explored
Medical aids offer hospitalization benefits, which cover the costs of in-hospital treatment and procedures.
In addition, the level of coverage depends on the type of plan you choose. For example, some plans provide private hospital stays and access to specialists. In contrast, others may only cover treatment in public hospitals.
Outpatient benefits cover medical treatments and consultations that do not require hospitalization. This may include visits to general practitioners, specialists, and diagnostic procedures.
The level of coverage will depend on the medical aid plan you choose.
Chronic Conditions and Medication Benefits
Many medical aids offer benefits for chronic conditions such as diabetes, asthma, and hypertension. This benefit covers the cost of medication and regular check-ups required to manage these conditions.
All medical aids cover the following Chronic Disease List conditions:
- ✅ Addison’s disease
- ✅ Asthma
- ✅ Bipolar mood disorder
- ✅ Bronchiectasis
- ✅ Cardiac failure
- ✅ Cardiomyopathy
- ✅ Chronic obstructive pulmonary disease (COPD)
- ✅ Chronic renal disease
- ✅ Coronary artery disease
- ✅ Crohn’s disease
- ✅ Diabetes insipidus
- ✅ Diabetes mellitus (Type 1 and Type 2)
and many more. A full list will be supplied by the provider.
Emergency Medical Benefits
- ✅ Emergency medical benefits cover unexpected medical emergencies, such as accidents or sudden illnesses. This may include emergency transportation, hospitalization, and treatment.
- ✅ Most medical aid schemes offer maternity benefits that cover prenatal care, childbirth, and postnatal care. Some schemes may also cover fertility treatments and adoption-related costs.
- ✅ Many medical aid schemes offer wellness programs, including preventative health screenings, counseling services, and lifestyle management programs. These programs encourage healthy habits and help members avoid or manage chronic diseases.
Dental and Optical Benefits
- ✅ Some medical aid schemes offer dental and optical benefits, which cover routine dental and vision care costs, as well as more complex procedures like orthodontics or corrective surgery.
Trauma and Counselling Benefits
- ✅ Medical aid schemes may offer trauma and counseling benefits, which provide access to counseling services during a traumatic event or mental health crisis.
- ✅ Some medical aid schemes offer travel benefits that cover emergency medical treatment while traveling, including medical evacuation and repatriation.
Some medical aid schemes offer rewards programs that incentivize healthy behavior. For example, members can earn rewards for exercising regularly, quitting smoking, or completing preventative health screenings.
Top Tips on how you can save on your monthly Medical Aid Premium
- ✅ Consider a cheaper plan:
- ✅ Choose a basic option, such as a hospital-only one with lower premiums. However, it is important to note that this plan will not cover out-of-hospital expenses. In this case, it may be wise to self-fund these costs.
- ✅ Trim the number of dependents on your medical aid plan:
- ✅ Removing dependents from your plan, such as independent adult children, can also save you money. Instead, consider placing dependents on their plans, which you can continue to pay. This way, you can avoid paying for unnecessary cover and only pay for the necessary cover for each family member.
- ✅ Consider switching to a plan with a higher excess or co-payment:
- ✅ You can reduce your monthly premium by agreeing to pay a certain amount upfront for medical procedures.
- ✅ Consider a Network or Income-based Plan:
- ✅ Joining a plan where the premium is based on your income can be a cost-saving option. This means you will only pay for the coverage you can afford based on your income level.
- ✅ Use preventative care:
- ✅ Many medical aids offer free preventative care services, such as annual check-ups and vaccinations. By taking advantage of these services, you can avoid developing more serious health conditions and reduce your need for costly treatments.
- ✅ Shop around:
- ✅ Do not be afraid to compare medical aid plans from different providers. You may find a plan that offers the same benefits as your current plan but at a lower cost.
- ✅ Use generic medication:
- ✅ Many medical aids offer discounts on generic medication, which can be just as effective as their brand-name counterparts but at a lower cost.
- ✅ Consider a medical savings account:
- ✅ Some medical aids offer plans to save money for future medical expenses. Contributing to a medical savings account can reduce your monthly premium and have funds available when needed.
The Pros and Cons of Medical Aid
Advantages of Medical Aid
- ✅ Medical aid offers financial protection against large medical bills.
- ✅ Prescribed minimum benefits, which include 271 medical conditions, are covered by medical aid.
- ✅ Medical aid provides cover for 26 chronic conditions, regardless of the plan you are on.
- ✅ Medical aid pays for medical surgeries and treatment costs, relieving the stress of saving up for these events.
- ✅ You can go to private hospitals and doctors instead of overcrowded public hospitals with medical aid.
- ✅ Joining a medical aid can result in tax savings through Medical Tax Rebates offered by the government.
Disadvantages of Medical Aid
- ✅Medical aid can be expensive, and fees tend to increase over time.
- ✅Medical aid may not benefit members with dependents in rural areas, as private healthcare facilities may not be available.
- ✅Hidden costs can exist in medical aid schemes, and members may have to pay some of the costs themselves.
- ✅Some schemes may impose benefit limits, such as the amount of money spent on prescribed medication per year.
- ✅ Medical aid schemes may not cover certain medical costs, leaving members to pay for these costs out of their own pockets.
Medical aid schemes may have waiting periods before members can access certain benefits or treatments.
How to Choose the Right Medical Aid in South Africa
In order to choose the right medical aid, a list of important factors should be considered. This includes:
- ✅ Consider Your and Your Dependents’ Health Needs
- ✅ Cover and Benefits
- ✅ Designated Service Provider (DSP) Network
- ✅ Monthly Premiums
- ✅ In-Hospital Cover
and many more.
Consider Your and Your Dependents’ Health Needs
- ✅ Although your past health does not determine your future health status, assessing your current and dependents’ health is important. Create a record of any pre-existing conditions or illnesses your family members have, including any chronic medication or treatment they require.
Next, compare the available benefits offered by medical aid schemes to your family’s specific needs. If you plan to have children in the future, selecting a plan that covers pregnancy, birth, and postnatal care is crucial.
Furthermore, remember that it is not possible to upgrade your plan option during a benefit year, so if you are planning to start a family in 2023 or later, it is advisable to select an appropriate plan that caters to your pregnancy and childbirth needs.
Cover and Benefits
- ✅ Does your medical plan provide various choices to tailor to your needs? One example is how the healthcare needs of a young, athletic individual differ from those of a family or an older business executive. Therefore, confirming the specifics of your cover and any applicable waiting periods before relying on them is always a good idea.
Furthermore, it would help if you remembered that hospitalization is only covered to a certain extent by some benefit plans. Therefore, you must ensure the benefits are suitable for your situation.
Your medical aid should provide a wide variety of affordable healthcare plans, including those for the next generation, the traditional, the hospital, and those requiring special managed care.
Designated Service Provider (DSP) Network
- ✅ It is important to consider Designated Service Providers (DSPs) and the medical aid network before signing up for medical aid because they can impact the cost and quality of care you receive.
DSPs are healthcare providers that have a contract with a medical aid scheme to provide healthcare services at agreed-upon rates. By using DSPs, you can save money on your medical bills, as the medical aid scheme may cover the full cost of the treatment, depending on the plan you choose.
In addition to DSPs, medical aids typically have a network of healthcare providers that they work with. Choose to use healthcare providers outside of the network. You may be responsible for additional costs or co-payments.
By understanding the DSPs and network providers available under a medical aid plan, you can decide which plan is best for you based on the healthcare providers you prefer to use, and the costs associated with those providers.
- ✅ To establish your financial feasibility at the outset, conducting a thorough budgeting process is recommended.
Although the premiums for medical insurance can quickly add up, as a general rule of thumb, they should not exceed 10% of your monthly budget. However, you must factor in your future ability to pay. Typically, medical inflation is expected to outpace consumer inflation by 3% – 4% annually.
After determining your budget for medical aid premiums, you will be better able to narrow down your choices. Be wary of choosing the cheapest premium because you get what you pay for because teams of actuaries and healthcare experts rigorously price all medical aids.
Therefore, if a plan’s premium is noticeably lower than comparable plans, it is probably because it has severe restrictions on access to specialists, low sub-limits, or high co-payments. It is also crucial to examine whether the scheme’s annual contribution increases have been disproportionate to its competitors.
Review the scheme’s contribution growth over the past 3 to 5 years. Therefore, if they have routinely outperformed the market, you should be wary and try to figure out why.
- ✅ Accessing private hospital care can be expensive and unaffordable for most people, making selecting the appropriate hospital plan crucial.
It is important to note that not all hospital plans are created equal, with entry-level options only covering in-hospital treatments at specific hospitals, often up to 100% of the medical aid tariff, which can be misleading.
Additionally, doctors and specialists can charge rates far beyond the medical aid tariff, leaving the patient to pay for the difference. You must identify what co-payments are required for procedures, radiology, pathology, scopes, scans, specialized dentistry, and specialist treatment, as many will require additional out-of-pocket expenses.
Furthermore, you must review the options available and weigh the benefits against the costs to make an informed decision that meets individual needs.
Chronic Conditions and Cover
- ✅ Most health insurance plans include coverage for chronic conditions.
However, it would help if you evaluated how well their plan fits your needs. All chronic conditions covered by the medical plan and the formulary of approved medications should be listed in the plan’s brochure or online.
You should investigate whether or not the specialized programs offered by some schemes for conditions like diabetes, cancer, HIV, and asthma will financially benefit you.
- ✅ Service quality is crucial when seeking medical help, so be sure to do your research.
Inquire about the timeliness with which claims are processed and paid, the friendliness of the customer service representatives, and how quickly your questions are answered over the phone.
Furthermore, determines who manages the medical aid and how satisfied previous patients were with their service.
Reputation and Financial Stability
- ✅ Find a medical plan that has been around for a while, has satisfied customers, and has built a solid reputation for itself.
In particular, looking into the medical plan’s claims payment history is important to ensure prompt and reliable payments.
Members and service providers experience frustration with the slow claims processing and payment capabilities of some poorly managed medical aids; as a result, many service providers avoid working with these medical schemes.
Exclusions and Waiting Periods
- ✅ The Medical Schemes Act and the rules of the particular scheme determine this.
Make sure you take the time to learn as much as you can about your chosen medical aid plan before signing up. Always read all correspondence carefully, including any fine print, to fully grasp the Scheme Rules.
Furthermore, do not hesitate to call the customer service line, your broker, or a financial advisor if you have any questions. Knowing your rights and making the most of your benefits will be much easier with this information.
Gap Cover Options
- ✅ Consider whether your medical aid offers gap cover before you sign up for it because it provides additional financial protection to cover the shortfall between what medical practitioners charge for their services and what medical aids are willing to pay.
Medical practitioners often charge higher rates than what medical aids are willing to pay. The difference between the medical aid and practitioner rates is known as the “gap.” This gap can leave you with a significant out-of-pocket expense, which can be financially burdensome.
Gap cover is a type of insurance designed to cover the difference between what medical aids are willing to pay and what practitioners charge, which can help you avoid these out-of-pocket expenses.
- ✅ Although loyalty and reward programs may seem appealing, you should not base your decision solely on how appealing the program is to you.
Instead, remember that your search’s primary goal is to secure medical coverage.
The program’s benefits and rewards may seem enticing at first. However, you will only see their full value if you participate in every aspect of the program, remain up to date on any changes to the program or your eligibility for rewards, and make regular use of the rewards you have earned.
Technology and Innovation
- ✅ Find out how well the medical scheme has integrated modern technologies to improve patient-provider communication, claims processing, and service delivery.
Members of technologically advanced medical aids can monitor their benefits, submit claims, locate healthcare providers, and communicate with doctors via online video or text chats, all from the convenience of their mobile devices.
Check that your prospective medical aid is current with the latest innovations and provides convenient, user-friendly features.
How to Enrol in Medical Aid
Eligibility to enroll in Medical Aid (What you require to be eligible for medical aid)
In South Africa, to be eligible to enroll in a medical aid scheme, you must meet the following requirements:
- ✅ You must be a South African citizen, a permanent resident, or have a valid work permit.
- ✅ You must be able to afford the monthly premiums.
- ✅ You must not have a history of fraudulent activities or providing false information to medical aid schemes.
- ✅ You must provide accurate and up-to-date personal information, including your identity number, contact details, and bank account information for premium payments.
- ✅ You must agree to the terms and conditions of the medical aid scheme, including any waiting periods or exclusions for pre-existing conditions.
You must meet any specific eligibility criteria the medical aid scheme sets, such as age restrictions or income requirements.
Enrolment / Registration Process
The process to enroll/register for medical aid in South Africa may vary slightly depending on the specific medical aid scheme you choose. However, in general, the following steps are involved:
- ✅ Research and compare medical aid plans. Research the various medical aid plans available in South Africa and compare their benefits, costs, and network providers to determine which meets your needs and budget the best.
- ✅ After selecting a medical aid plan, fill out the application form with all the required information, including personal information, medical history, and dependents, if applicable.
- ✅ Fill out the application. Submit the completed application form to the medical aid scheme online, via email, or in person.
- ✅ The medical aid will review your application and determine your membership eligibility. Depending on the scheme, this procedure may take several days to weeks.
- ✅ Acceptance and payment. You will receive membership confirmation and a contribution schedule if your membership application is approved. To activate your membership, you must pay the first month’s premiums.
- ✅ Once your first payment has been made, you will receive your membership card and any other pertinent documentation from the medical aid.
Finally, Familiarise yourself with your benefits. Ensure you know the benefits your medical aid scheme provides and how to access them. This will allow you to maximize your benefits and avoid unforeseen out-of-pocket costs.
Understand Waiting Periods
After your application has been underwritten, a medical plan may impose waiting periods before coverage begins. Furthermore, you cannot register for medical aid and receive cover if you disagree with these waiting periods.
You and your family members may be subject to these waiting periods:
- ✅ There is typically a 3-month waiting period after leaving medical aid.
- ✅ Suppose you have a pre-existing medical condition and want to join. In that case, you must wait a year before receiving any benefits. You should be fully covered after that time has passed.
To safeguard the scheme, waiting periods are permissible when a new member files a claim immediately upon joining, then leaves the scheme and goes back to an old plan, where they may have already used up their benefits but prefer the terms of the new plan.
However, despite waiting periods, the following are exempted from mandatory waiting periods:
- ✅ Prescribed minimum benefits (PMBs).
- ✅ A member’s dependent child who was born during the membership year.
- ✅ A member who changes benefit plans must wait until any applicable waiting periods from the prior plan are over before receiving the new plan’s benefits.
- ✅ When an employee is forced to switch pension plans because of a job change.
- ✅ Cases where employers implement annual medical plan changes.
There is a waiting period during which you must make payments.
Consider Late Joiner Penalties
Late joiner penalties are additional fees that individuals must pay if they join a medical aid scheme for the first time after age 35 or if they have a gap in their medical aid cover of more than 90 days.
The late joiner penalty is calculated based on the years an individual did not have medical aid coverage after age 35.
Understanding and Managing Your Medical Aid Cover
Understanding and managing your medical aid coverage is essential to ensure that you get the best value for your money and that you are not caught off guard when you need to claim your medical aid. Therefore, one of the key aspects of understanding and managing your medical aid coverage is understanding your benefits. Your medical aid benefits refer to the medical expenses covered by your medical aid plan. Other terms and conditions to take into account include:
Medical Aid Premiums:
A medical aid premium is a monthly fee that an individual or family pays to be a medical aid scheme member. This premium provides access to various medical benefits and services, including hospitalization, outpatient care, chronic medication, and emergency medical services.
The premium amount can vary depending on the type of plan selected, the level of coverage provided, and the number of individuals covered under the plan.
Medical Aid Co-Payments:
A medical aid co-payment is a fee that a member must pay when receiving certain medical services in addition to the amount covered by the medical aid scheme.
Co-payments are often applied to elective medical procedures, such as cosmetic surgery or specialized scans. They are intended to discourage members from overusing medical services and help control the costs of the medical aid scheme.
Medical Aid Deductibles:
A medical aid deductible is an amount a member must pay out of pocket before their medical aid scheme begins to cover the cost of medical services. For example, if a medical aid plan has a deductible of R5,000, the member would need to pay the first R5,000 of medical expenses themselves. Then the medical aid scheme would cover any additional costs.
Deductibles are often used to reduce the overall cost of medical aid premiums, as they require members to take on some monetary responsibility for their healthcare.
Paying from Risk vs Medical Savings Accounts
- ✅ When you join a medical aid scheme, you can pay your medical expenses from your Risk or your Medical Savings Account (MSA).
- ✅ Your Risk portion is the money you pay into the scheme each month to ensure that you are covered for major medical expenses, such as hospitalization, surgery, and specialist treatments. This money is kept separate from your Medical Savings Account.
- ✅ On the other hand, your Medical Savings Account is a separate account used to pay for day-to-day medical expenses, such as GP visits, prescription medication, and other medical services. A portion of your monthly contributions to the scheme funds this account.
Prescribed Minimum Benefits (PMB)
The Prescribed Minimum Benefits (PMBs) refer to a specific range of benefits intended to guarantee all medical plan members have access to a minimum level of healthcare services, regardless of the particular benefit option they have chosen.
Therefore, the objective is to provide people with continuous care to improve their health and well-being and reduce healthcare costs.
General and Condition-Specific Exclusions
Medical aid general exclusions refer to medical conditions, treatments, or services not covered by the medical aid scheme under any circumstances. These exclusions are not negotiable and are typically specified in the medical aid scheme’s policy documents.
Some common general exclusions include cosmetic surgery, infertility treatments, experimental treatments, non-prescription medication, and non-medical services like cosmetic dentistry or spa treatments.
Claims and Reimbursements
Medical aids typically manage claims and reimbursements as follows:
- ✅ Claims submission: The healthcare provider (doctor, hospital, etc.) submits a claim to the medical aid on behalf of the member, providing details of the services rendered and the costs involved.
- ✅ Claims assessment: The medical aid assesses the claim to determine if it is covered by the member’s plan and if the treatment was medically necessary. They also check if the member has any waiting periods or exclusions that apply.
- ✅ Reimbursement: Once the claim has been approved, the medical aid will reimburse the member or the healthcare provider for the covered costs up to the limit of the member’s available benefits.
The reimbursement may be paid directly to the healthcare provider (in the case of in-hospital treatment) or the member (in the case of out-of-hospital treatment). In some cases, the member may have to pay the healthcare provider upfront and then claim back the expenses from the medical aid.
The reimbursement amount will depend on the type of plan the member has and the limits and deductibles that apply. Some medical aids also have preferred providers, and members may receive higher reimbursement rates if they use them.
Renewals and Upgrades
Medical aid renewals and upgrades typically work as follows:
- ✅ Renewals: Medical aid schemes usually offer annual renewal of the medical aid cover. The Member has to review their cover and confirm whether they want to continue with the same plan or switch to a different one.
- ✅ Upgrades: Upgrades are regularly available at any time during the year. Members can upgrade to a more comprehensive plan to get better benefits or add additional benefits, such as dental or vision coverage, specialized treatments, etc.
To renew or upgrade, members should follow these steps:
- ✅ Members should review their current policy to determine whether it still meets their needs. They should check to see if there have been any changes to the policy, such as benefit reductions or increases in premiums.
- ✅ Members should evaluate other plans offered by their medical aid scheme or other schemes to determine whether they offer better benefits, are more affordable, or better suit their needs.
- ✅ Members should contact their medical aid scheme to discuss their options and make any changes to their policy. The scheme may help select a new plan or upgrade to a more comprehensive one.
Once a member has submitted their request for a renewal or upgrade, they should wait for confirmation from the medical aid scheme. The confirmation will typically include details on the new plan, premiums, and benefits.
Medical Aid Frequently Asked Questions
What is Medical Aid?
Medical Aid is a type of health insurance that assists individuals and families in paying for hospitalization, doctor visits, and prescription drugs. Medical Aid plans vary in cost and coverage and are typically offered by private businesses or organizations.
How do I choose the right Medical Aid plan?
Your needs and budget will determine which Medical Aid plan is best for you. Consider factors such as your health, the level of coverage you require, and the plan’s cost. Consult with a financial advisor or healthcare professional for assistance in making the best decision.
What is the drawback of Medical Aid?
Medical Aid can be costly, and the more comprehensive the cover, the more expensive it is. In addition, some Medical Aid plans have waiting periods before certain benefits can be accessed, and coverage for certain treatments and procedures may be limited.
How does Medical Aid work?
Depending on the coverage the specific plan provides, Medical Aid pays for all or a portion of an individual’s medical expenses. Members pay monthly premiums to their Medical Aid scheme, which, subject to the terms and conditions of the plan, provides cover for medical services and treatments.
Who can get Medical Aid?
Any citizen or permanent resident of South Africa may join a Medical Aid. Nevertheless, eligibility for certain plans may be contingent on age, health status, and pre-existing conditions.
How much does Medical Aid cost?
Medical Aid costs vary based on the level of coverage and the specific plan selected. In addition, age, health status, and pre-existing conditions can also influence the price of Medical Aid.
What are the benefits that are covered by medical aid schemes?
Medical aid schemes assist you in meeting your healthcare needs, such as doctor’s appointments, nursing, surgery, dental work, optometry, medicine, and hospitalization when necessary.
Can a person have two medical aids?
No, section 28 of the Medical Schemes Act 131 of 1998 prohibits the joining of more than one medical scheme.
What is the maximum age for medical aid?
Because there is no maximum age for entering a scheme, pensioners, retirees, and members over 60 can readily obtain medical aid.
How many medical schemes are there in South Africa?
The CMS regulated 75 registered medical schemes in 2021, a decrease from 76 in 2020.
Why is medical aid important in South Africa?
Having medical aid is frequently less expensive than not having any at all. Medical aid assists with the payment of all forms of medical operations, treatments, doctor’s visits, and consultations, many of which are costly in and of themselves. As a result, it is critical to select a plan that is appropriate for you and your circumstances.
How long does it take to get medical aid approved?
Typically there is a three-month waiting period before your medical aid is approved unless you are switching plans within the same scheme.
What happens to your savings when you cancel medical aid?
All of the previous year’s medical cost savings are distributed to members in the new year. Your unused portion of this year’s savings will be determined by the program when you withdraw from membership. Any remaining funds will be distributed to you at this time, or you may be required to make a repayment to the scheme.
Can you withdraw savings from your medical aid?
You cannot withdraw your cash savings unless you leave the scheme. If you leave the scheme, you can only use your savings to offset any obligations you owe the scheme, such as contributions.
What documentation is required for medical aids?
When you apply for medical aid, you must supply a certified copy of your ID document, your tax number, and either a bank statement, a canceled cheque, or a confirmation letter from your bank.
Can medical aids refuse to pay?
Medical aids may refuse to cover treatment in two situations: The treatment may be non-essential, which means that it is either not a treatment that has been definitively demonstrated to be useful or that it has no effect on one’s health and lifespan.
Can I change my Medical Aid plan?
Yes, you can change your medical aid plan. However, most schemes only allow you to do this once at the end of the year.
Can I choose my own doctor with Medical Aid?
Yes, you can. However, it depends on the particular plan and Medical Aid scheme. For example, some plans permit members to select their preferred doctor or healthcare provider. In contrast, others require members to utilize providers within a specific network.
Do Medical Aids provide cover when traveling outside South Africa?
Numerous Medical Aid plans offer coverage for medical expenses incurred outside South Africa. However, reviewing the plan’s details is essential to determine the cover’s scope and any limitations or restrictions.
How long does it take to get Medical Aid?
The time required to obtain Medical Aid depends on the specific plan and scheme. For example, some plans may require a waiting period before cover, while others may provide immediate cover.
Is Medical Aid Mandatory in South Africa?
Medical Aid is not required in South Africa. However, it is strongly recommended due to the excessive cost of medical care.
Can I cancel my medical aid?
Yes. Whether or not a member gives notice of termination, they must continue making contributions in full through the end of the notice period. A medical plan might file suit to recoup unpaid contributions or request that the termination be retroactively effective as of the last contribution date.
How do I cancel my Medical Aid?
You must contact the scheme and adhere to its cancellation procedures to cancel a Medical Aid plan. Noting that cancellation may be subject to certain terms and conditions, such as potential financial penalties, is essential.
Can I still get Medical Aid in South Africa if I have a pre-existing condition?
Yes, qualifying for Medical Aid with a pre-existing condition is possible. However, cover for this condition may be limited or subject to a waiting period depending on the specific plan and Medical Aid scheme.
Can you claim back from medical aid?
If you prepay for medical services, the program will reimburse you. The decision to issue a refund, and the amount of any such refund, will be based on your individual medical Choice and benefits, as well as the applicable scheme regulations and rates.
Can you have medical aid while you are not working?
Whether you choose to enroll in medical aid or a hospital cash plan, you won’t face any bias based on your job position. That’s right—even if you’re out of work, you can still enroll in a medical aid plan.
What happens if you don’t pay medical aid?
The procedure is as follows: if a premium payment is overdue, coverage will be canceled and no claims will be reimbursed. If the overdue payment is made, the membership will be reinstated. During the suspension period, all claims that were not paid are processed again.
When can your medical aid cancel your membership?
It makes no difference whether or not a member serves the termination notice; they are still responsible for making full contributions for the entirety of the notice period. Legal action could be taken by a medical scheme in order to recoup unpaid contributions, or the scheme’s dissolution could be retroactively pushed back to the date on which it received its final payment.
Where can I lodge a complaint against medical aid?
The CMS accepts complaints using its online form. It should be emphasized, however, that before seeking the Council for help, a potential complainant should always try to settle the problem through the complaints mechanisms in place at the particular medical scheme.
How long do I have to pay a medical bill?
No matter when you get it, 30 days is the typical amount of time you have to pay off a medical bill. However, the time period for which payments can be made varies from provider to provider and hospital to hospital.
What is a medical scheme shortfall?
A medical scheme shortfall is the difference between what your medical scheme pays for certain medical treatments and the actual cost of the treatment.
What are co-payments?
Co-payments are a portion of the medical costs you must pay out of your pocket and what your medical scheme pays.
What are Prescribed Minimum Benefits?
Prescribed Minimum Benefits (PMBs) are benefits that medical schemes must cover by law.
Do you get money back from medical aid?
When you pay a healthcare service provider in advance, you can get a return from the scheme. We will make a refund based on your medical option and benefits, as well as the applicable plan rules and rates.
What are the in-hospital benefits of medical aids?
This covers hospitalization as well as specific specialized surgeries and treatments, as well as specialized scans. It provides option-specific benefits that cover you if you are hospitalized or require surgery.
Can I claim medical aid contributions from SARS?
Yes. Contributions must have been paid in respect of a specific tax year in order to be taken into account for that tax year.
Who are the Top 5 Medical Aid Schemes in South Africa?
The Top 5 Medical Aid Schemes in South Africa are Momentum, Discovery Health, BestMed, Bonitas, and Fedhealth.
What is the cheapest medical aid in SA?
There are several affordable medical aid schemes in South Africa, and Momentum offers the Ingwe Option from 482 ZAR per month.