How to Choose Medical Aid Plans in SA

By Janice Roberts

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It’s coming to that time of year when we all need to take a long hard look at the medical aid plans we belong to and decide whether to stick with what we’ve got, upgrade or move providers.

Comparing medical aids in South Africa can get tricky so here at Fedhealth we’ve compiled some tips on what to look out for when making your decision.

  1. Providers: It’s important to go with a medical aid plan provider that is dependable and established. Ask yourself the following questions about your potential provider:
  • How long has the medical aid scheme been around?
  • Is it financially stable?
  • Is it governed according to the Medical Schemes Act?
  1. Once you’ve done this, take a look at your medical expenses in the last year, asking yourself these questions:
  • Was most of your expenditure on regular doctor and dentist visits? Will the medical aid plan you’re thinking of going with provide enough funds to cover similar expenses next year? Look for schemes that cover things like GP consultations from risk benefits, rather than your savings account. This will make your savings last much longer.
  • Are you anticipating any unexpected expensesin the future? For example, starting a family means you need excellent maternity benefits.
  • How old are you?Perhaps you’ve reached a certain milestone in life and as you get older you realise that you’re going to need more comprehensive benefits. Perhaps it’s time to upgrade your medical aid plan?
  1. Now it’s time to decide whether or not you want a medical savings account (MSA) or just a plain hospital plan.There are a wide variety of medical aids in South Africa to choose from, so consider your choices carefully.

If you choose an option without an MSA, you will need to pay for daily visits to the dentist and doctor out of your own funds. Ask yourself whether you’re young, independent and healthy enough to do this or if you have dependants that may need more regular trips to the doctor.

  1. Look at your annual limits

Perhaps you know that your teenage son is going to require a lot of orthodontic appointments this coming year and you need to decide how to budget for that.  These types of expenses come out of your day-to-day and would be paid from your member’s savings account.

If the option that you are on has a threshold benefit, the scheme often limits how much of the orthodontic treatment costs they will accumulate up to your threshold level. Once you’ve reached the threshold benefit, schemes also limit how much they pay for orthodontic treatment from this benefit, so be sure to check this out. 

  1. At what rate will you be covered?

It’s worth bearing in mind that some medical aid plans only pay 100% of the medical scheme rate, while top of the range options or plans offer up to 300% of the medical scheme rate.

Remember that if the specialist you see charges more than the medical scheme rate, then these expenses have to be paid out of your own pocket. Find out if the scheme has network arrangements with specialists for in-hospital treatment. These arrangements often mean that if you use one of these specialists for your in-hospital treatment, the scheme will cover the cost in full without you having to pay for any shortfalls or make any co-payments.

  1. Prescribed minimum benefits and chronic medication

All medical aid schemes in South Africa have to cover a chronic disease list of 25 conditions, known as the prescribed minimum benefits. Schemes may also insist that you use a designated service provider to obtain your chronic medicine for these 25 conditions, so be sure to bear this in mind. Some schemes also use formularies; a list of medicine that they cover on their chronic medicine benefit.

  1. Are there any restrictions?

Cheaper plans often have more restrictions, which enables the medical aid provider to make it more affordable to you. Take a look at whether you’re limited to certain hospitals or doctors and if this will suit you and your family.

Once you’ve considered all of these things, you’ll be better equipped to choose the right provider and medical aid plan for your unique needs. At Fedhealth, we’ve just released our plans and prices for 2016, offering loads of great benefits and coverage options. And if you have a question about medical aids in South Africa, we’d be happy to help.

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