It’s time to do an annual review of your medical aid plan

Decoding your medical aid terms and conditions and associated costs is not an easy task. As we approach the end of November, time is running out to decide which medical scheme and plan will best suit your needs in 2019.

Here are a few pointers for you to consider:


  • Before starting your research, remember that you get what you pay for

Medical Aid Schemes operate on the principle that the contributions received from members should cover any claims paid out. The way to control this is to limit the benefits based on what you can afford to pay. This is why there are so many varieties of plans offered at different price points. There is a direct correlation between cost and benefits – the more the plan costs the more the benefits. As a guide, consider how often you may need to use your medical aid. The more frequently you use your medical aid, the more comprehensive your plan will need to be. Be cautious of very cheap plans with hospital cover – you get what you pay for, and will no doubt have a limit in your hospital cover or a massive co-payment. The better plans have unlimited hospital cover which means you won’t have to leave after a few days, allowing you to stay for as long as the procedure or recovery period requires.

  • Don’t make hasty decisions based on immaterial value adds

While medical aid loyalty programmes have become a big attraction for some (with cheaper movie tickets and gym memberships), be careful not to make this the sole driver when deciding on a medical aid. These are just ‘bells and whistles’ and can distract you from some of the not so great aspects of your medical aid plan. All these ‘nice to have’ benefits won’t pay for your medical bills when you need it.

  • Start by understanding the cover you already have and how it may change for 2019

It’s no secret that the average consumer in South Africa is feeling the pinch of a tough economy and may be looking for ways to reduce monthly living expenses. The following average weighted medical aid premium increases were announced for 2019:


  • Bonitas – 8.9%
  • Bestmed – 9.9%
  • Discovery – 9.2%
  • Fedhealth – 8.4%
  • Genesis – 6.5%
  • Momentum Health – 10.7%
  • Medshield -14.5%
  • Topmed – 9.9%


Unfortunately for the consumer, all these increases in membership contribution rates are significantly higher than general inflation which is currently at 4.8%. Also bear in mind that schemes need to contain their costs in the face of increasing claims, and in some instances may have changed some of the benefits you have enjoyed on your current plan. For this reason, an annual review of your plan is essential. You won’t want to find out down the line that you are no longer covered for something that you were covered for before.

  • Decide what benefits are the most important to you and your family for 2019

Most people choose their medical plan based on cost, the levels of medical cover provided, day-to-day limits on medical expenses and chronic benefits. While this is not wrong, there are some other factors to consider as well. Be sure to study all the benefits in line with your needs and then compare costs. Avoid choosing on cost alone.

Administration – Get an idea of who administers the scheme and if they have a good track record in processing claims. On occasion, you may need to fund a doctors account upfront. You don’t want to be in a situation where it takes months to get your money refunded.

Reimbursement Rate/Coverage – Most schemes pay claims at between 100% to 300% of their own Medical Scheme Rate which is created using the National Health Reference Price List (NHRPL) as a guideline. If you need to settle for a plan with lower coverage, then you might want to factor in gap cover, an affordable insurance product that covers the shortfalls on in-hospital specialist expenses.

Exclusions – Medical plan brochures are great at punting the benefits of the plan, but what about exclusions? These are as important in terms of what is covered, and this can change from year to year.

Co-payments – Co-payments on certain procedures are common but often overlooked when choosing a medical aid plan. Nobody expects to go into hospital or to undergo certain procedures. However, investigating these upfront as part of your annual review is critically important. Co-payments are expenses that you will have to fund out of your own pocket should they occur. Co-payments differ from scheme to scheme and sometimes depend on whether the procedure is done in or out of the hospital.

Preferred Provider Networks – More and more medical schemes are negotiating preferred rates with their own network of doctors, specialists, pharmacies and hospitals in order to contain costs. Using a doctor or provider outside of this network could result in penalty co-payments and/or claim rejections. Before you choose a plan with these stipulations, first make sure your preferred service provider is covered and/or part of the schemes network.


In summary, to find the right medical aid scheme and plan for your needs will require thought and time. You need to be comparing at least five of the top medical aids in South Africa before deciding.

If all of this seems too overwhelming, there is an easier way. has an instant comparison tool that allows you to compare benefits and price all in one place. The comparison looks at a monthly premium, hospital choice, overall annual limit, cancer cover, reimbursement rate, day-to-day cover, benefits, MRI/CT scans, maternity benefits and chronic cover.

This is a great way to get started and can save you a lot of time. Visit now and make an informed decision for 2019.