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Understanding medical scheme options

Understanding medical scheme options

Medical schemes have various benefit plans available to members. Members have to choose between hospital plans, hospital plans with a savings component (New Generation Options), traditional plans, comprehensive plans and network plans.

If your savings benefit is quickly depleted at the beginning of the year and you have to pay for expenses out of your own pocket, or if your option is too expensive, it would be worthwhile to reconsider your particular medical plan. Certain schemes allow migration to other options mid-year, while others allow such changes only at the end of the year. Continue reading

Medicalaid Information you need to know

Medical Aid – The Basics

What are the basic principles of medical aid – how does it work?

South Africa has a dual healthcare system, consisting of public and private providers. Private hospitals are used mostly by members of medical schemes or those able to pay for these services out of their own pocket.

Medical aids are regulated by the Medical Schemes Act (1998). They are essentially non-profit organisations and belong to their members. Continue reading

Medicalaid Benefits

Benefits, exclusions and limitations

Benefits can become complicated. For your own good, here’s what you should know.

Medical schemes undertake liability in return for a premium or contribution. They are required to help their members in obtaining healthcare services and defraying expenditure for such services. The benefits that a scheme may grant must be registered in its rules. Continue reading

Choices

Important considerations when choosing a medical scheme

Before choosing a medical scheme, and an option within that medical scheme, you need to consider the following points:

Needs and financial analysis

When deciding to join a medical scheme, first ask yourself what you can afford to spend on the monthly premium per month. Then look at your and your family’s needs. What is it that you need from your medical scheme? Continue reading

How and why people join medical schemes

How and why people join medical schemes

Various factors enable groups of individuals to join medical schemes.

People need to understand the social solidarity nature of medical scheme cover.

Most South Africans join a medical scheme through their employment. Another reason why individuals join medical schemes is because they are seeking a perceived higher quality of care in the private sector, particularly for hospitalisation. Most people cannot afford to pay out-of-pocket for private hospitalisation, therefore they enrol in medical schemes.

There are people who join medical schemes purely because they are risk-averse, meaning that they are not compelled by their employer to do so but join because they understand the catastrophic nature of healthcare expenditure. Medical scheme cover gives these individuals access to better resourced healthcare facilities that would otherwise be beyond their reach. Continue reading

PMBs and Chronic Diseases

PMBs and Chronic Diseases

What are PMBs?

Prescribed Minimum Benefits (PMB) is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and well-being and to make healthcare more affordable. Continue reading

Understanding Medical Aid Tariffs

Understanding Medical Aid Tariff

What does ‘100%, 150%, 200%, 300% and 400% of scheme tariff’ mean?

Medical aid quotes and brochures often state that the scheme will cover your in-hospital costs at 100% of the scheme tariff.

But surely 100% is, well, 100%? If you’re charged more than that, aren’t you supposed to get money back? Not necessarily in this case. Continue reading