Medical schemes and health cover: Which one is right for me?

March 29, 2016 MedQuote

In South Africa there are a number of medical aid plans available. Members can choose between hospital plans, hospital plans with a savings component, traditional plans, comprehensive plans and network plans.

All of these range in the benefits offered and, of course, the price. If you want the most affordable medical aid that fits your healthcare needs, you need to understand what the product has to offer before you join. 

Basic hospital plans are recommended for an active and healthy family. If you take responsibility for your own health and know that prevention is better than cure, it could be the viable option to consider. However, the disadvantages include co-payments on certain procedures such as gastroscopy, colonoscopy, laparoscopy, extraction of wisdom teeth, cataract removal, etc. Some procedures might also not be covered at all. 

(More members these days choose to have a basic hospital plan with a gap cover policy as complementary health cover product. For more information on gap cover, click HERE). 

Comprehensive plans are medical scheme membership with a savings component and covers almost all medical expenses and include benefits for in-hospital, day-to-day expenses and chronic medication. These benefits are subject to the rules of the specific scheme and are recommended for individuals or a family who needs (and can afford) comprehensive cover for emergencies, hospitalisation, day-to-day expenses and who makes use of quite a lot of chronic medication.

Traditional plans don’t have a savings component and gives you a set number of benefits linked to a certain category (as determined by that specific medical aid). The members could therefore still get benefits for in-hospital, day-to-day expenses and chronic medication, but it’s limited. These plans are recommended for families with children, who know they have certain benefits that they will regularly use (GP visits, basic dentist visits and buying over the counter and prescription medication). Even if a certain benefit runs out through the year (which you will have to pay out of pocket), the plan will still cover other set benefits such as emergencies, hospitalisation, etc.

Hospital plans with savings cover accounts (New Generation Options) are an alternative to the traditional plan. A certain amount of money is debited into your medical scheme account, and the member can choose how to allocate the money further, i.e. GP visit, optometry, medication, physiotherapy, etc.
Once the amount is finished, you’ll have to fund any day-to-day benefits yourself.

There are also combinations of a traditional and new generation option available, which makes the selection process even more complicated. The benefits and options of each medical scheme can also be slightly different.

The best way to select the medical scheme option that is best for you and your family is to get advice and recommendations based on your specific needs and budget. 

Request your medical aid quote online and an accredited healthcare broker will contact you to discuss and assist you with the comparison and different options available so you can make an informed decision. 

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