Medical Aid

Medical Aid Schemes have one main function in mind

How does a Medical Aid work?

Medical Aid Schemes have one main function in mind; to help people pay for their healthcare needs. Such as hospitalisation, treatments, medicine and other medical-related expenses. Medical aid schemes are actually non-profit organisations, where resources are pooled by a large number of contributing individuals who can then access this money when they need to pay for various medical expenses. In a medical aid scheme, members pay a monthly amount called a premium or contribution into a “collective pot” that is administered by the scheme. This money is then used to pay out medical claims made by members.

Here are key benefits
that Medical Aid can provide

Quality Healthcare

Medical aid ensures that members have access to a wide range of healthcare providers, such as hospitals, specialists, general practitioners and pharmacies. This enables members to receive timely and appropriate care when needed.

Financial Protection

High medical costs can lead to significant financial strain. Medical aids help protect individuals and families from these expenses by covering a portion or the entire cost of healthcare services, depending on their chosen plan.

Preventive Care

Many medical aid plans include cover for preventive services, such as routine check-ups, vaccinations, and screenings. This benefit pays for certain tests that can detect early warning signs of serious illness.

Prescription Medication cover

Medical aid often includes cover for prescription medications, ensuring that members can afford the medication they need to manage chronic conditions or treat acute illnesses.

Key differences between Medical Aid
and Medical Insurance

Medical Aid

Regulation: Medical Schemes Act

Range of Cover: Wider

Premiums: Typically Higher

Claim Processing: Typically Faster

Medical Insurance

Regulation: Long-Term Insurance Act (LTIA)

Range of Cover: Narrower

Premiums: Typically Lower

Claim Processing: Typically Slower

Additional factors to consider

Your Budget

Medical aid premiums are typically higher than Medical Insurance premiums.

Your Health

If you have any chronic conditions or are expecting to have major medical expenses in the future, then Medical Aid may be a better option for you.

Your Lifestyle

If you travel frequently or participate in high-risk activities, then you may need more comprehensive health insurance cover like a Medical aid Plan.

What's not covered?

What are the different types of medical aid plans available?

Medical aid plans typically come in different tiers, often referred to as bronze, silver, gold, and platinum. These tiers generally offer varying levels of cover and come with different monthly contributions. Bronze plans typically have the lowest monthly cost but offer the least comprehensive cover, while platinum plans offer the most extensive cover but come with the highest monthly fees.

What are some of the things typically covered by medical aid insurance?

Medical aid insurance usually covers a range of healthcare services, including:

Hospitalization: Costs associated with inpatient care, including surgery, room and board, and medication.
Doctor visits: Consultations with specialists and general practitioners.
Certain prescribed medications: cover for medications listed on the plan's formulary.
Diagnostic tests: X-rays, blood tests, and other diagnostic procedures.

It's important to note that specific cover can vary between plans, so carefully review the details of your chosen plan to understand what is and isn't covered.

Are there any waiting periods before I can use my benefits?

Many medical aid plans have waiting periods before you can access certain benefits. This typically applies to pre-existing conditions, where cover may not be available until after a specific period, usually ranging from 3 months to 12 months. Additionally, some plans may have general waiting periods before covering any benefits, although this is less common.

Can I choose my own doctor or hospital with medical aid insurance?

Some medical aid plans offer access to a wider network of doctors and hospitals, while others may have more limited networks. Depending on your plan, you may have different levels of cover for services received outside the network. Check your plan details to understand any limitations regarding in-network and out-of-network providers.