5 Best Medical Aids with Value for Money
The 5 Best Medical Aids with Value for Money in South Africa revealed.
We tested them side by side and verified their medical aid plans.
This is a complete guide to the best medical aid with Value for Money in South Africa.
In this in-depth guide you’ll learn:
- What is a Medical Aid?
- What is considered affordable for medical aid in South Africa?
- What benefits do you get for the price you pay for medical aid?
- Should you rather get medical aid or a hospital plan?
- How do you get the most out of your medical aid?
So if you’re ready to go “all in” with the best medical aid with value for money in South Africa, this guide is for you.
Let’s dive right in…
Best Medical Aids with Value for Money (2023)
| 🩺 Medical Aid | ✔️ Offers Affordable Medical Aid Plan? | ⚕️ Monthly Premium | 👉 Sign Up |
| 1. Momentum Health | Yes | From R300 | 👉 Apply Now |
| 2. Medihelp Medical Aid | Yes | From R300 | 👉 Apply Now |
| 3. Discovery Health | Yes | From R300 | 👉 Apply Now |
| 4. Bestmed | Yes | From R300 | 👉 Apply Now |
| 5. Genesis | Yes | From R300 | 👉 Apply Now |
5 Best Medical Aids with Value for Money Summary
- Momentum Medical Aid – Overall, Best Medical Aid with Value for Money
- Medihelp Medical Aid – Broadest Range of Low-Cost Medical Aid Plans
- Discovery Health – Best Customer Care Medical Aid
- Bestmed – Best Pay-As-You-Go Private Healthcare
- Genesis – Top Extensive Healthcare Protection in South Africa
Overview
Many private hospitals require payment up front from patients without medical aid. In the event of an emergency, private facilities are obligated to stabilise uninsured patients before transferring them to a public facility, where the will likely receive inadequate treatment at these strained and resource-deprived hospitals and clinics.
As such, having a medical aid plan in South Africa is essential in order to ensure that you and your family are covered in the event of illness, injury or a medical emergency.
But medical aids can be pricey, so that its important to ensure that you are getting the most out of your cover. Here, we explore the 5 best medical aids that offer value for money.
What is value for money when it comes to a medical aid scheme?
It’s impossible to predict what will happen in life. Even with the best of plans, life always seems to throw you a curveball.
When you’re unprepared, the effects of events like accidents and illnesses can have a much greater toll. If you have medical aid, you won’t have to worry about drowning in debt after an accident or illness, which is excellent value for the money.
When calculating the return on investment of medical coverage, think of the peace of mind you’ll have knowing that, should a member of your family become ill, they will have the financial resources to receive the care they need. The individuals you care about the most matter the most in times of crisis. You can do your part to make sure your uninsured friends and family members get the care they need by having a conversation with them or by sending them this article.
There are many other health issues that still exist and people are being diagnosed with every day. These include diabetes, arthritis, cardiovascular disease, and cancer.
You still need medical aid even after the worst of SARS-CoV-2 has gone and life returns to normal, in case of any unforeseen misfortunes. If you have been saving for your health and now have medical aid, you should be thankful for the return on your monthly investment.
Getting the most out of your medical aid scheme
When purchasing a medical aid plan, use caution. Consider the following elements, or take advantage of these benefits, to ensure you’re receiving good value for money:
- Use only doctors and healthcare providers who are members of the scheme’s medical aid network and charge medical aid prices.
- Choose generic medication, which is less expensive than branded medication and is still covered by a medical aid plan.
- Before visiting a specialist, obtain a recommendation letter from your primary care physician. This ensures that your claim is not denied.
- Use the medical aid’s preferred network of service providers, such as hospitals, general practitioners, specialists, and pharmacies. Your medical aid plan will only cover authorised healthcare providers or services. Furthermore, the medical aid scheme will have negotiated preferential prices with these networks, potentially saving you money.
- Sign up for chronic medicine. Your doctor will need to fill out forms detailing your chronic ailment, such as diabetes or high blood pressure, and send them to your medical aid provider for approval. If you do not register, the fee will be charged from your daily costs rather than your medical aid money.
- Resolve your bill with the medical practitioner and file a claim with medical aid. Some healthcare practitioners and pharmacies will charge a transaction fee as well as a handling fee. This amount will be debited from your medical savings account.
- Living a healthy lifestyle lowers your chances of being sick, especially from preventable diseases like colds and flu. Exercise, eat a healthy diet, and get those screenings, medical check-ups, and flu shots.
- Choose the appropriate medical aid plan for you depending on your age, gender, health, individual healthcare demands, day-to-day needs, and budget.
- Learn about your personal healthcare risks depending on your lifestyle and family medical history.
- When deciding on a medical aid scheme, disclose any pre-existing conditions. If you fail to reveal the specifics of your disease, your claim will be rejected.
- Examine your medical aid plan. Read the small print. Learn what it covers and what it does not. It’s also a good idea to be aware of any exclusions, limitations, or waiting periods.
- Use any loyalty programmes or bonuses that come with your specific plan. These may differ from one medical programme to the next, but they frequently include discounts or cash-back advantages on retail purchases, travel, and other items.
- When you are young, get medical aid. Don’t be a late joiner, which is someone beyond the age of 35 who has never been a member of any type of medical aid scheme. Members who sign up later will pay greater monthly premiums than those who sign up early.
- Reduce the cost of your plan. If you can’t pay the monthly charges, consider lowering your medical aid plan rather than cancelling it entirely, as this will leave you vulnerable if you require healthcare services.
- Seek expert assistance. If you have any questions about your medical aid plan, call your service provider and speak with a consultant who can clarify the procedure, plan, or specifics to you.
1. Momentum Medical Aid
Overview
Momentum Health has resulted in a large number of satisfied South Africans. Momentum Health is South Africa’s third-largest medical aid scheme, with 284,400 subscribers. Momentum provides a plethora of alternatives. There are many options available, including public, private, and network hospitals.
- There are 33 plans available in 6 different scheme types to choose from.
- When it comes to hospital stays, there are no yearly caps.
- Momentum’s rewards programme includes medical scheme benefits.
- These range from 26 to 62 different chronic conditions.
How Much Are Momentum Health Monthly Premiums?
Momentum monthly premiums start at R1 539 for the main member on the Evolve Option and go up to R12 345 for the main member on the Summit Option.
What Is the Waiting Period for Momentum Health’s Benefits?
The general waiting period is 3 months, but since pregnancy is considered a pre-existing condition, it is excluded from all benefits for the first 12 months of scheme membership.
How to Claim for Momentum Health Benefits
You can submit a claim in several ways:
- Use the Momentum App
- Use the web chat facility in the bottom left corner.
- Send an email to [email protected] or send normal mail to PO Box 2338, Durban, 4000
To make sure your claim is processed quickly and accurately, include the following information:
- Membership number.
- Principal member’s surname, initials, and first name.
- Patient’s surname, initials, and first name.
- Date of treatment.
- Amount charged.
- ICD–10 code (code to indicate what condition you’ve been diagnosed with), tariff code (product-specific code for procedures and claims), and NAPPI code (unique identifier for a given ethical, surgical, or consumable product).
- Service provider’s name and practice number.
- Proof of payment if you’ve paid the claim out of your own pocket.
Momentum Health Contact Details
201 Umhlanga Ridge Blvd
Cornubia
Blackburn
PO Box 2338
Durban
2. Medihelp Medical Aid
Overview
This health insurance plan is excellent since it offers complete coverage. The customer service is excellent, and the website is straightforward to use.
- The Medihelp plans fall into four different scheme groups.
- A pregnancy benefit is available.
- They provide comprehensive protection against over 270 PMBs and 26 other chronic diseases.
- There is no cap on hospital coverage.
- They provide infinite protection for accidents and medical emergencies.
- With Prime plans, you’ll pay for only the first two kids, and any more kids will be covered at no extra cost.
- There is also a Medihelp emergency app.
How Much Are Medihelp Medical Scheme’s Monthly Premiums?
Medihelp monthly premiums range from R756.00 pm for the student hospital plan, R1 254.00 pm for the Vital Plan, R2 310.00 pm for the Savings plans, and R2 394.00 pm for Comprehensive plans.
What Is the Waiting Period for Medihelp Benefits?
Depending on the medical aid scheme you join, the average waiting period for NetCare benefits is three months. Pre-existing conditions have a 12-month waiting period.
How to Claim for Benefits from Medihelp Medical Scheme
Members can submit claims using one of the following:
Doctors and healthcare practitioners usually submit claims for their services directly to Medihelp on your behalf, but some healthcare practitioners require you to pay their accounts first and then claim a refund from Medihelp.
To ensure that your claim is valid according to the Medical Schemes Act and Medihelp’s Rules, please ensure that the following details appear on the printed account:
- Your membership number and correct dependant code (e.g., “01” for the principal member)
- The member’s name and surname
- The name, surname and date of birth of the patient
- Medihelp Medical Scheme – not “Private” (this has tax implications)
- The healthcare practitioner’s name and practice number
- Your proof of payment (attached)
- The amount you have paid
- The amount charged per item
- The relevant codes such as ICD-10, NAPPI and item codes
- The date on which the service/procedure was rendered/performed
Medihelp Medical Scheme Contact Details
086 0100 678
3. Discovery Health
Overview
The number of people who stand to benefit from Discovery is enormous. Over 2.5 million beneficiaries are presently assisted by Discovery with their healthcare bills. You might be wondering why Discovery Health Plans are so popular in South Africa. Here’s why Discovery Health is so popular:
- Across seven different scheme categories, Discovery provides twenty-seven distinct medical insurance plan options.
- Vitality Points are provided, which may be used for savings on things like gym memberships, movie tickets, and more. Advantages like discovery miles, which can be used for airline tickets, are also available.
- Hospitalization costs are fully covered by all Discovery Medical Aid plans.
- Most medical aid plans let you visit any private hospital you like.
- You can also take advantage of the program’s screening and prevention services, which can help you identify potentially life-threatening conditions.
- Once your emergency funds are gone, you can still rely on Discovery for day-to-day support.
How Much Are Discovery Medical Aid Monthly Premiums?
Monthly premiums start from R930 per member for the KeyCare Series with medical cover for both in-hospital and out-of-hospital treatment by providers in a specified network and goes up to R8 298 per member for the Executive Plan with extensive cover for in-hospital and day-to-day benefits, extended chronic medicine cover, and unlimited Above Threshold Benefit.
What Is the Waiting Period for Discovery Medical Aid’s Benefits?
Discovery Health Medical Scheme’s general waiting period is 3 consecutive months and the condition-specific waiting period is 12 consecutive months.
How to Claim for Discovery Medical Aid Benefits
You can submit a claim fast and easy in the following ways:
- Scan and upload your claims on the website.
- Scan and email your claims to [email protected].
- Use the Discovery app on your smartphone. If the claim has a QR code, scan the QR code or alternatively take a photo of the claim from within the app.
- You can also submit your claims by post.
Discovery Medical Aid Contact Details
PO Box 784262,
Sandton,
2146
Phone: 0860 99 88 77
Read more about Health Insurance / Medical Insurance
4. Bestmed
Overview
Bestmed is one of South Africa’s largest open medical plans, following the exclusive LA-Health Medical Plan. Bestmed’s members and dependents are expected to number 96,489.
- Provides 13 plans Across 3 scheme categories.
- Self-administered, which means that most of your payments go towards benefits and less towards administration;
- No self-payment gaps;
- Fewer co-payments;
How Much Are BestMed Medical Aid Monthly Premiums?
At the time of writing, monthly premiums for the cheapest BestMed Beat1 Network Hospital Plan started at R1 710 for a member, with an additional R1 329 for an adult dependant and R720 for a child dependant, to a maximum of 3 child dependants. Additional children join at no additional cost.
The most expensive plan at the time was the Pace4 Comprehensive Plan, with monthly contributions of R9 411 per member and R9 411 per adult dependant. For a child dependant the extra contribution was R2 205, up to 3 child dependants with additional children added as beneficiaries of the scheme at no extra cost.
You might also consider the following options BestMed has to offer:
- BestMed Beat 3 Network
- BestMed Beat 1 Network
- BestMed Tempo
- BestMed Pace 4
- BestMed Pace 3
- BestMed Pace 2
- BestMed Pace 1
- BestMed Rhythm 2
- BestMed Rhythm 1
- BestMed Beat 4
- BestMed Beat 3
- BestMed Beat 2
- BestMed Beat 1
What Is the Waiting Period for BestMed Medical Aid’s Benefits?
There can be a general waiting period of three months or a specific waiting period of 12 months for a certain condition.
BestMed Medical Scheme will sometimes only pay a claim if it is a PMB. This can happen if you are in a waiting period or if you are getting treatment for a condition that your plan doesn’t cover.
How to Claim for Benefits from BestMed Medical Aid
If your healthcare provider does not submit claims to BestMed, one must submit the original claim directly to the fund administrators.
You can claim by means of the BestMed App, or by scanning and emailing your claim to them.
Details that should appear on all claim documents include:
- Member’s name and contact details
- BestMed membership number
- Patient’s details
- Service provider’s name, contact details and practice number
- Details of treatment, including applicable tariff and ICD-10 codes
- Whether payment should be done to the service provider or the member
You will receive an email confirmation when your claim is received and indexed.
BestMed Medical Aid Contact Details
Head Office:
BestMed Medical Scheme, Glenfield Office Park, 361 Oberon Avenue, Faerie Glen, Pretoria
PO Box 2297
Pretoria
Emails: [email protected]; [email protected],
Phone: +27 (0)86 000 2378
5. Genesis
Overview
According to the Hellopeter.com ranking, Genesis is one of the best open medical plans in South Africa, based on variables such as member satisfaction, financial strength, membership growth, average beneficiary age, and quality of service.
It is one of the most cost-effective healthcare plans available in South Africa, according to the most recent GTC Healthcare Consulting Medical Assistance Survey.
Your premiums will include a provision for any uninsured medical bills.
Every three months, these payments are made to your account (any amount in that account is added).
- All hospital charges, including room, board, surgery, physical therapy, and laboratory fees, at 200% of medical aid rates.
- Private hospital ICUs and outpatient clinics that provide round-the-clock treatment are examples.
- Conditions requiring a transplant organ, chemotherapy, or radiation therapy are covered
- Your own fund to cover non-medical medical expenses.
- Help in an Instant
- Cover for persistent diseases
- There are no yearly quotas.
- Minimal out-of-pocket costs.
How Much Are Genesis Medical Aid Monthly Premiums?
Genesis Medical Aid premiums are highly competitive and range from R1 465.00 to R2 815.00
Genesis Medical Scheme has the following plans:
What Is the Waiting Period for Genesis Medical Aid’s Benefits?
Genesis Medical Scheme’s general waiting period is 3 consecutive months and the condition-specific waiting period is 12 consecutive months.
How to Claim for Genesis Medical Aid Benefits
- Genesis will accept signed claims by the principal member via e-mail, fax, post or by hand.
- Where a member has paid an account, please attach the receipt to the claim. Claims can be scanned and e-mailed to [email protected] or faxed to 021 447 4707.
- Alternatively, a PDF document(s) or a good quality photo (image) of the claim, clearly indicating your membership details, may also be emailed to the Scheme directly from your Smartphone App.
- Always ensure that you insert your membership number in the “Subject Line” of claims that are sent via email.
- Monthly statements will be sent to each member that has claimed in that month. Alternatively, members can log in to the secured Member section on the website or mobile app to view the status of their claims.
- Genesis encourages members to check that the services were in fact rendered to them or their dependents.
Genesis Medical Aid Contact Details
Email: [email protected]
Existing Members – 0860 10 20 10
New Members – 0861 56 46 66
Frequently Asked Questions
How do I choose a good medical aid in South Africa?
Consider your present healthcare needs, past treatments and expenditures, how much you can afford, premium hikes, the scheme’s claim payment record, and overall in-hospital restrictions. It is also critical to assess the plan’s exclusions and limitations, as well as whether you require gap coverage.
How can I save money on a medical aid?
We’ve included some ideas for how to save money on your medical aid without having to cancel or compromise your essential features.
- Use a Network Plan
- Consider an income-based plan
- Don’t pay for benefits you don’t need
How much should I spend on medical aid?
The general rule is that these should not exceed 10% of your monthly income, either as a person or as a household.
How much tax can you claim from medical aid?
If you are 65 or older, or under 65 and disabled, or your spouse or a child dependent is disabled, you are eligible for a tax credit equal to 33.3% of your out-of-pocket expenses.
How do funds on medical aid schemes work?
Members of a medical aid system pay a monthly sum known as a premium or contribution into a “collective pot” that is managed by the programme. This money is then utilised to pay members’ medical claims.
