Choosing

In this post we examine and give you a better understanding of the types of Medical Aid Cover available in the South African Private Healthcare arena. After all Medical Aid Cover can be confusing at the best of times.

Types of Medical Aid Cover Plans Available In South Africa…

Traditional Plans

These cover inpatient hospital costs as well as outpatient Day-to-Day medical expenses, but check the benefits carefully, sometimes there are limits and sun limits to the amount you can claim in a given year. These plans are generally expensive and offer generous sub limits and members have no incentive to act prudently and manage their expenses. The approach is one of “use it or lose it”

New Generation Plans (These Plans can be categorised into 3 different products)

Comprehensive Plans

These cover inpatient hospital costs as well as outpatient Day-to-Day medical expenses. The difference here is that the Day-to-Day medical expenses cover is provided in the for of a Medical Savings Account. Once you have exhausted the Medical Savings Account there is an element of cover provided by the Medical Scheme in the form of an Above Threshold Benefit subject to certain limitations and sub limits. These products can be fairly pricey and are generally aimed at members and their families who want comprehensive inpatient hospital cover and have large cumulative Day-to-Day medical expenses.

Hospital Plans With Limited Day-To-Day Medical Expenses

These cover inpatient hospital costs as well as outpatient Day-to-Day medical expenses in the for of a Medical Savings Account. The Medical Schemes Act limits your Medical Savings Account to a maximum of 25% of your total month contribution. Product may vary according to the percentage allocated in a Medical Savings Account. These products have proved to be popular in South Africa as the Medical Savings Account concept works on the basis of providing an annualised credit facility of funds being made available so that members can manage their yearly Day-to-Day medical spend. The principle of the Medical Saving Account is “what you do not use – you do not lose”. At the end of the year any surpluses are carried forward to the following year and so on.

Hospital Plans

These cover inpatient hospital costs and do not offer outpatient Day-to-Day medical expenses cover. These products have also proved to be popular in South Africa as many members either elect to fund their Day-to-Day medical expenses cover as and when they happen. Another reason for their popularity is that comprehensive Medical Scheme cover can be expensive and consumers are primarily worried about the “big hit” In-Hospital.

Capitation Plans – Network Plans

These cover inpatient hospital costs as well as outpatient Day-to-Day medical expenses cover in the form of basic primary healthcare. Inpatient hospital cover is generally restricted to a network of hospitals. In addition the Day-to-Day primary healthcare cover is restricted to a network of contracted service providers. These products are generally aimed at the Lower Income Market and are designed to give members access to Private Hospitals and basic primary healthcare Day-to-Day cover. However one needs to see whether or not contracted Hospitals and Service Providers are conveniently located near one’s place of residence or workplace.

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When evaluating which type of Medical Aid cover best suits your particular need criteria and affordability, it is advisable that you speak to a Professional who can help guide you in making an Informed Option choice.

Medical Aid Self-Tester