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Everything You Need To Know About Medical Aid

Having medical aid is an absolute essential in South Africa, especially when you consider how overburdened the state institutions are.

We had a look at all the information available online and realised that while there are hundreds of articles available on medical aid, many of them are hard to digest for people who aren’t in the industry, and we wanted to simplify a few things for our clients.

Firstly, medical aid is essentially health insurance used for financial protection against the risk of incurring medical expenses during your and your family’s lifetime. What this means is that if you are injured, sick or hurt, your medical aid can be used to pay part, most or all of the expenses when this happens. This will depend on the type of cover you have, the incident and healthcare professional or institution (hospital or clinic) you use at the time.

You pay a monthly premium, which seems simple enough, but different plans include different things, so it’s important to work through this with an advisor who understands the products, and more importantly understands your family’s needs and financial standing. You shouldn’t pay more than you can afford for a plan you won’t use, but in the same breath, you don’t want to go for a plan that simply won’t cover what you need.

The main benefit of having medical aid in place is that it gives you access to excellent healthcare, but it’s important to understand what your medical aid will and won’t cover, what hospitals and doctors you can see, if you will need to pay in a certain amount when you go over and above your monthly premium, and if so, it’s important to find out if you need another product on top of your medical aid in order to compensate for what you might not be able to financially.

There are Gap Cover products available when medical aid schemes don’t cover the full amount, and if you don’t want the surprise of a big financial windfall when something goes wrong, on top of the stress of being ill or having a family member being ill, it might be a good idea to look at adding one of those as a top-up.

There are different plans when it comes to medical aid:

  • Comprehensive – these plans cover most medical costs including day-to-day and in hospital expenses. This means going to the doctor and getting booked into the hospital. These plans provide the most extensive cover. Comprehensive medical aid covers often only offer limited or restricted in-hospital benefits at 100%, 150%, 200% or 300% of the scheme’s rate, and often medical professionals can charge much more than this, meaning that you are still not 100% covered, so you would still need to pick up the outstanding amount or shortfall at the end.
  • Hospital Plans – these plans only cover the cost of treatment while in hospital and do not cover any day-to-day expenses.
  • Hospital Plans with Medical Savings – these plans are a combination of a hospital plan with the added benefit of a savings account that is topped up by your monthly contributions which can be used over the year, and when the funds have been exhausted the member would have to pay themselves, but if there are funds leftover they are carried over to the next year.
  • Network or Capitation Plans – these plans work within a group or network of hospitals and doctors, offering cover for day-to-day or in-hospital expenses which are more cost effective than traditional cover.

There is so much more we could add to this topic, but we don’t want to overwhelm you. Keep an eye out for our next post on Gap Cover.

For anything else, feel free to get in touch with us😊

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