Your guide to medical aid in South Africa

Whether you have a simple hospital plan or comprehensive cover, medical aid is designed to protect you in the event of illness, or health issues. It’s not always easy to know which plan to choose, let alone understand exactly what sort of coverage is best suited to your own unique circumstances. 

To help you find the best plan for your needs, we’ve put together some useful tips that cover everything you could ever need to know about medical aid.

Medical aid basics 🏥

We have a dual healthcare system that’s made up of public healthcare providers, and private healthcare providers. 

Public hospitals and clinics work on a reduced cost model that uses a percentage of each patient’s earnings to provide low-cost healthcare services. 

Private hospitals and doctors work on a full cost model. As a patient, your options include paying in full for medical services or making use of a medical scheme that pays part, or all, of your healthcare costs.

Comparing medical aid plans 💭

In order to find the right coverage and provider, you’ll need to compare medical aid plans. There are so many different plans available, each designed to cater to specific needs. 

If you currently have health issues, you may find that a certain plan adds more value than another. Likewise, if you’re generally healthy and you’re not taking any chronic medication or visiting the doctor often, you may find that a standard plan is best. 

Comparing medical aid plans helps you look at your options to see what plan offers. This makes it far easier to make your decision according to your needs, and of course, your budget. 

Not all schemes are equal. Shopping around is essential to compare things such as the overall cover, day to day limits on expenses, claim conditions, and chronic benefits. 

To compare plans, think carefully about the following:

• Your health. Which plans seem right for your health? Which suits your lifestyle? Think about whether you’re active, dealing with chronic illness, pregnant or currently trying to get healthy
• Your budget. Which plans have coverage that you can realistically afford each month? 
• Your needs. Which plan gives you the most value? Compare medical aid plans, and look beyond the extra frills such as benefits to find those that genuinely add value

The different medical schemes

Once you have narrowed down your options, you can move on to the next step – choosing medical aid schemes. Here is a simple breakdown of the most common types of coverage:

Comprehensive schemes

The standard comprehensive plan is designed to cover any and all medical expenses that may arise, according to the specific scheme’s guidelines. Dedicated medical aid for pensioners is offered with comprehensive plans, along with numerous other tailored plans.

Hospital plans

Hospital plan schemes focus only on costs you’ve gained only while you’re in the hospital and don’t include doctors, medication or other health services. 

Medical savings account

This type of plan covers day-to-day expenses. You may get an account outside of your comprehensive coverage or your hospital plan. You’ll pay a fixed amount to a dedicated savings account.

Making your medical aid provider choice 🚑

Now you’re ready to start thinking about how to choose your medical aid provider. This step is one of the easier steps if you’ve taken the time to do some research in advance. Consumer review Platforms such as Hellopeter offer a valuable way to compare providers, and see what other people are saying.

Over and above offering affordable medical aid, providers should also be able to deliver a high level of customer service, have a smooth claims process, and have a system in place that does not cause frustration when you’re trying to change your plan or get help.

We hope these tips have helped make it easier to find affordable medical aid. If you’re new to this type of insurance, you may find it confusing initially. Each insurer has plenty of promises that can make it harder to know what to believe and what to take with a pinch of salt. 

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