Medical Aid Checklist: The Secret to Choosing the Right Medical Aid

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Before deciding on a medical aid, it’s important to know what you want. There is a way to make sure that you cover most, if not all, of your requirements in a medical aid before even applying.

Where To Start?

Below is a medical aid checklist you can use to determine your personal medical aid requirements. I have also expanded on the specific requirements below.

Personal Medical Aid Requirement Checklist

 

YES
√ 

NO
√ 

1. Do I require day-to-day medical cover for doctors’ visits, dentists etc.?    
2. Am I comfortable with using network hospitals?    
3. Do I require maternity benefits?    
4. Do I require cover for over-aged children who are still students?    
5. Do I require cover for a chronic condition, e.g. diabetes?    
6. Is my chronic condition a PMB*?    
7. Do I require a wellness programme for discounted gym, flights etc.?    


[tip title=”moneysmart tip”]*PMBs or Prescribed Minimum Benefits are the minimum benefits which all medical schemes must provide to their members according to law.[/tip]

1. Do I require day-to-day medical cover for doctors visits, dentists etc.?

How often do you go to the doctor or dentist? If more than two or three times a year you might consider an option that will cover you for these visits.

Schemes and options to consider:

Bonitas Bonsave/Primary/Standard, Discovery Saver/Priority, Medihelp Prime 2/3

2. Am I comfortable with using network hospitals?

Many schemes make use of network hospitals in order to “save” costs and are able to provide you reduced premiums as a result of the payment arrangements they have with these hospitals.

If you’re comfortable with the use of network hospitals, first check the list of hospitals on the scheme you’re interested in to make sure that the hospital in question will, in fact, suit you. 

3. Do I require maternity benefits?

There are certain schemes that provide very rich maternity benefits, which will not affect any other savings/day-to-day benefits.

A maternity programme would typically include between 6-12 visits to the gynaecologist, growth scans and some other related benefits.

Schemes and options to consider:

Bonitas, Momentum, Medihelp

4. Do I require cover for over-aged children who are still students?

Should your children still be full-time students and you’d like to keep them on your medical aid as child dependants, you would need to look at the maximum age for children on the chosen scheme. Most schemes only cover children up to age 21 (if full-time students).

Schemes and options to consider:

Fedhealth, Liberty

5. Do I require cover for a chronic condition, e.g. diabetes?

Should you be taking ongoing medication for a condition, you could qualify for the medication to be covered from the schemes’ chronic medicine benefit.

6. Is my chronic condition a PMB*?

All medical schemes must cover the 26 PMB conditions, however if your condition were not on the list, you would look at a more comprehensive plan that might cover your condition.

7.  Do I require a wellness programme for discounted gym, flights etc.?

Wellness programmes like Vitality and Multiply provide you with discounted benefits, e.g. gym, flights and healthy food. If you would use these benefits, you should choose a scheme that offers them.

Schemes and options to consider:

Discovery, Liberty, Momentum, Profmed and Resolution

Medical Aid Scheme Checks

It’s always a good idea to have a background of the scheme you’re considering.

By knowing certain information, you will have an indication of whether the scheme will be around a year from now.

The following would be some points to look at: 

  • Solvency levels
  • Size of the medical aid scheme (total number of members)
  • Average age of members
  • Scheme growth
  • Pensioner ratio
[tip title=”moneysmart tip”]Should you have made the wrong decision regarding your medical aid option, you can change to another, more appropriate option at the beginning of each year (without any penalties). If you wish to move to another scheme at any time during the year you can do so. Just keep in mind that, depending on your previous membership and health status, there might or might not be certain restrictions/exclusions.[/tip]

Not on a medical aid yet? Complete the form below and an agent from one of our trusted partners will get back to you with a quote.

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About Author

Nelda Celliers is a medical aid advisor based in Cape Town. She has a Higher Certificate in Insurance through the Insurance Institute of South Africa. Nelda obtained her licenses from the Financial Services Board and Council for Medical Schemes to operate her own medical aid practice, Medical Benefit Advisors.