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Key things to consider when choosing medical aid cover in SA

Written by Vuyile Madwantsi

South African healthcare operates on the two-tiered system that is arguably linked to socio-economic disparities. Naturally, there are benefits and drawbacks to both public and private health care.

The availability of public health care comes with a number of disadvantages, including lengthy waiting times, rushed appointments, obsolete facilities and inadequate disease management and prevention methods. Due to the vast economic differences in our country, other citizens have the option of private care.

The private healthcare sector has advantages over the public health-care system, such as short waiting times, flexible appointment scheduling, superior facilities and efficient disease management and prevention techniques.

The quality of state-provided health care has been steadily declining. In South Africa, few people would have the money to get medical care without medical aid. Spending even a week in hospital can leave a financial dent.

Because of this, we must do our research before selecting a medical aid in terms of coverage and pricing. Finding the correct medical plan to support you as you navigate the health-care system can be challenging given the variety of possibilities.

Lee Callakoppen, principal officer of Bonitas Medical Fund, explains that there are 17 open medical schemes in South Africa, each with its own set of plans and benefits. “Trying to decide what is best can be a little overwhelming, which is why we advise consulting a medical aid broker or financial adviser.”

Brokers are eligible to provide advice and support at no additional cost since they have been accredited by the Council for Medical Schemes (CMS).

Before selecting a medical aid plan, you and your partner can talk through the many options. The financial stability of the schemes is another factor that brokers are aware of, and it should be taken into account when making a final choice.

The majority of medical plans include a variety of health-care options, including traditional medical aids as well as hospital, savings, network, or income-based plans that help reduce the cost of private health care.

Medical aid in South Africa: what to consider


Determine what you can afford by carefully reviewing your monthly budget plan. Contributions should not be greater than 10% of your monthly income.

Health status:

To decide what coverage you require, assess you and your family’s health at the moment. Consider pre-existing diseases or illnesses, any chronic medications or treatments that you or your family members take, how frequently you visit a doctor or specialist, how much you spend on dentistry or optometry, as well as any chronic medications or treatments. This will help you decide whether you need comprehensive medical aid or a hospital plan.

The fine print:

It’s crucial to take the time to read everything. Benefits vary from plan to plan, so you need to establish what is and isn’t covered. Find out if any supplementary benefits could help you save money on daily expenses.

These might include the advantages of preventive care, which could encompass everything from routine blood pressure, cholesterol, blood sugar and body mass index (BMI) assessments to mammograms, Pap smears and prostate exams. These can occasionally include things such as maternity programmes, dental exams and flu shots. Once you understand what is on offer, you can make an informed comparison and decision.

Are you required to use a specific GP, hospital network, or designated service providers?

Although this helps keep costs down, you need to check the network in your area before making a final decision.

Having to be referred to a specialist by your GP?

Does your medical plan offer additional GP consultations, which they will pay for after you have exhausted your day-to-day benefits?

Find out what is included in the plan you are thinking about, as well as if you can access your benefits, make claims, locate health-care providers, use WhatsApp chat, and access your medical information online at any time. Age is another factor to consider because it will impact your decision.

To make a decision, you should look at the demographics and size of the scheme, as well as the increase in contributions over the past few years, to see how these compare with the industry’s average.

Callakoppen asserts that “health is a new wealth. Your health is important, as are your finances. Don’t take either for granted.” She suggests spending some time researching and figuring out what you need when it comes to health insurance.

Rockfin Financial Services independently offers our clients only the best advice and options on the market to ensure our clients can safeguard themselves and their dependents with the cover offering best suited to their needs and budget. Contact your Financial Advisor today to reanalyze your health insurance options for 2023

*Read the original article here