Find health care that offers you, and your family comprehensive cover
Health care services provide you with a membership to a registered medical aid scheme to which you will pay a monthly premium.
Your membership ensures you are covered for various health expenses which include emergency treatment, hospitalisation, general preventative care, and medication.
How do medical schemes work?
Health care companies such as Discovery and Bonitas collect premiums from their members which are then used by the same members and their beneficiaries to pay for medical expenses.
Medical care services manage the money they collect from their members and their objective is to ensure their members have access to quality healthcare as needed, and that the medical payments are available and paid accordingly.
What claims does your health care cover?
Any medical scheme will at the very least cover all the minimum prescribed benefits as set by the Medical Schemes Act 1998 which is a set list of conditions.
In addition to the PMB, your specific health provider plan will provide certain benefits and limits which will regulate what medical expenses you’ll be covered for.
Do I really need health cover in South Africa?
The short answer is yes. With a strained and overburdened public healthcare system getting prompt, quality preventative and emergency medical care is best assured by making use of our elaborate private medical industry.
What are the minimum prescribed benefits?
Prescribed Minimum Benefits refer to a specified list of 271 medical conditions and 26 chronic conditions that all members must be covered. It also includes any life-threatening or emergency condition.
You can get onto a health care plan for just over R485 per month for a lower-tier plan and up to R7,500+ per month for the high-tier plans.
Can you get cover if you’re unemployed?
You can still become a member of a medical scheme in South Africa if you are unemployed and there are many affordable options to choose from.
You can get cover if you are self-employed and no medical scheme will reject you based solely on your employment status.
Can you be covered by more than one company?
You may not have more than one medical aid membership as this would be considered fraudulent and could result in your membership being terminated by both scheme providers.
How do I apply for cover?
To apply for a plan you will need to provide a copy of your ID or passport and a completed membership application form. If the service provider requires any further information or documentation such as medical records, they will request these later.
Can you be refused a membership?
You may not be refused membership based on your age or based on the existence of any pre-existing conditions.
A child under the age of 18 years cannot be the principal member of a scheme so you cannot get a medical plan only for a child.
What is a late joiner fee?
If you are over the age of 35 years and were not a medical scheme member or beneficiary on or before the 1 of April 2001 or had a gap in cover for more than three consecutive months after this date you will be charged a late-joiner fee.
The late joiner fee is calculated based on the number of years that a person was not part of a medical plan after the age of 35. The penalties are as follows:
- 1 to 4 years – 5%
- 5 to 14 years – 25%
- 15 to 24 years – 50%
- 25 years or more – 75%
A medical cover provider will cover you immediately for any emergency medical treatments but may impose a 3 to 12 month waiting period on pre-existing conditions.
What is the difference between Medical aid and a hospital plan?
The main difference is that hospital plans will only cover you for in-hospital treatment and have no day-to-day benefits while a medical plan will cover you for in and out-of-hospital treatments with a range of day-to-day benefits.
A health care plan will provide you with more comprehensive cover and is advisable for children and the elderly who have greater day-to-day medical care needs.
Hospital plans are ideal for those who are young and healthy and are looking for emergency-care cover only.
How can you compare schemes from different providers?
You can compare medical plans online, by using an insurance quote comparison website, or by making use of a broker or consultant who will help you select the best option for your needs and budget at no cost to you.
How to choose the best plan?
Choosing a health care provider is a matter of accessing your needs and budget and finding the plan that best suits you.
You should ask yourself how much cover you and your dependents need as well as how much you’re willing to spend on premiums before selecting a plan.
The top 5 companies in South Africa by number
- Discovery Health with 2.8 million beneficiaries
- Bonitas with just over 700,000 beneficiaries
- Momentum Health with 300,000 beneficiaries
- Medihelp with just over 200,000 beneficiaries
- Bestmed Medical Scheme with just under 200,000 beneficiaries
Who is the best provider in South Africa?
Based on the number of members, the best medical aid provider in South Africa is Discovery with 1.3 million members and close to 3 million beneficiaries. Bonitas comes in second place with 300,000 members and over 700,000 beneficiaries.
That said numerous customer surveys have pegged Bestmed and Medihelp as leaders when it comes to service excellence and quality care.
Who regulates medical plans in South Africa?
Medical scheme companies such as Discover, Bonitas, and Momentum are all regulated by the Medical Schemes Act of 1998 and the Council for Medical Schemes (CMS).
The Council for Medical Schemes is a statutory body that supervises and regulates the private health sector and more than 80 medical schemes.
How can I make a complaint against my medical plan provider?
You can make a complaint against your medical scheme company through the Council for Medical Schemes which is the regulatory body established by the Medical Schemes Act of 1998.
Complaints can be made online via the CMS website, via email, or by post and you should get acknowledgement of your complaint in writing within 3 days of receipt. Within 4 days of providing this acknowledgement, they will review it and send it through to the medical scheme involved for comment.
The company concerned will then be obliged to provide a written response to the complaint within 30 days. The CMS will then have to conclude within 210 working days after it has received all the relevant information and evidence.
How can you cancel your cover?
You will need to provide your medical aid scheme with 30 days’ notice that you intend to cancel your membership which can be done through their call centre or via email.