Medical Aid First-Timer? Here’s What You Need to Know


Like most forms of insurance, medical aid can get a little confusing. Not only are there more options out there than you can shake a stick at, but there are also various levels within each scheme.

Here are a few things to know before signing up to your first medical aid:

Medical Aid vs Hospital Plan

The first decision you will have to make is if you want comprehensive medical aid cover or a hospital plan.

A hospital plan is essentially medical insurance that only kicks in once you’re admitted to hospital.

It doesn’t cover any treatment outside of a hospital visit, such as GP visits or physiotherapy, and makes your monthly payments far less than a standard comprehensive medical aid scheme.

Why choose comprehensive medical aid then?

While expensive, the costs pale against those that you could accrue if you are diagnosed with a chronic, lifelong condition.

If you Choose a hospital plan you might then decide to go with a medical savings plan as well. A medical savings plan is designed to cover your day-to-day medical expenses.

You contribute a fixed amount per month but have full access to the annual total from the very start. This allows you to pay off the occasional medical expense without incurring any debt.

Spoilt for Choice

When it comes to medical aid there are a plethora of options to choose from.

The most popular medical aid in South Africa is Discovery Health with over 60% of the market.

Other popular options are Bonitas medical aid, Momentum Health, Fedhealth and Medshield.

All five are financially stable and the choice between them would be a personal one.

As a consumer you need to choose the plan that suits your needs, rather than going for the most affordable option.

Terms and Conditions

Whichever option you choose for healthcare cover, there will always be a long list of terms and conditions.

These terms, such as PMBs or Prescribed Minimum Benefits, explain what the medical aid will cover and what you will need to pay out of your own pocket.

There are various levels one can select but knowing what you are covered for before signing on the dotted line is the best way to avoid any nasty surprises.

One thing to keep in mind is that most medical aids have waiting periods. These apply when joining for the first time or moving between medical aids.

Essentially they are periods where you will not be covered for chronic, condition-specific ailments.

This period can vary from scheme to scheme, from a general three month period to up to a year depending on the ailment.

In Conclusion

Choosing healthcare can be difficult. Your best defence against any unexpected pitfalls is research.

Do your homework on the scheme you’re planning on joining and know your rights.

The Medical Schemes Act does protect the consumer from forms of discrimination and fee embellishments.


About Author

A master of the English language, Paul only uses his powers for good. No topic is too vast, no subject too frivolous for this carpal-ed crusader. Armed with a mighty vocabulary and a love for all things written, he virtually strides the world wide web writing every wrong. Um, otherwise known as a Freelance Content Creator based in Cape Town.