How does health cover and medical aid schemes work?

March 29, 2016 MedQuote Health

How does health cover and medical aid schemes work?

It’s a reality for SA residents: If you want the best and quickest medical treatment should you or your loved ones get ill or injured, then you need medical scheme cover.

Medical scheme membership helps with the payment of healthcare needs such as doctor and dentist visits, surgery and other hospital procedures, etc. To access medical aid cover you need to pay monthly premiums based on the specific option and list of benefits you chose.

The medical schemes in South Africa are non-profit organisations and must be registered in accordance with the Medical Scheme Act.

The medical schemes differentiate themselves with regards to the options and benefits they offer within their selective plans. All medical schemes must however according to law provide a minimum set of benefits to its members (i.e. Prescribed Minimum Benefits or PMBs).

A Board of Trustees that are elected by the scheme’s members are the responsible body that manages to scheme on behalf of its members. Members should ensure they join a medical scheme that are financially sound and are able to deliver when members need to claim. The Council for Medical Schemes regulates the medical schemes in South Africa and members can consult with them regarding any scheme issues.

In South Africa we have two types of medical schemes:

Closed medical aid schemes

These schemes are only open to a particular employee groups within a company, profession, trade, industry, association or union that have established a scheme exclusively for their personnel and /or members.

Open medical aid schemes

These schemes are open to the public. There are currently 26 open medical schemes in South Africa. Their benefits are much more innovative.

Some of the top open medical aid schemes in South Africa:

Bestmed Bonitas Discovery
Fedhealth Genesis Keyhealth
Liberty Medihelp Medshield
Momentum Health Profmed Resolution Health
Sizwe Spectramed Topmed

To see which open medical scheme would be the best fit for your healthcare needs, click HERE.

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