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