11 June 2021

South Africa has a well-developed medical aid industry that offers individuals and families a broad range of private healthcare funding options.

For those in the fortunate position of being able to afford medical aid this provides an abundance of choice and increases the likelihood that the specific needs of each individual and family can be met. The benefit of having such a wide array of options from which to choose, does create complexity. We therefore urge our clients to allow us to assist them by providing a better understanding of the option that would serve their unique healthcare funding needs and financial affordability.

To assist in this process it is important to first understand the 4 main options which is offered. It’s advisable to first establish the option (type of cover) that will best serve your needs. Thereafter compare the benefits across different providers before making a final choice based on which provider within your chosen option best matches your needs.

Understanding Your 4 Medical Aid Options

Option 1: Network/ Capitation Option

Entry level premium: *R750 p/m

*Rate for single individual at date of publication.

This option covers day-to-day benefits like GP and dentist visits, prescription medicines and hospital treatment within a predetermined network of doctors, pharmacies and hospitals.

NOTE:

• You may only make use of certain doctors, specialists, pharmacies and hospitals. Cover may not be possible for certain procedures such as joint replacements.
• Network providers will differ by medical aid.
• It is common for these options to base the premium payable on income. Income below a certain level may result in a lesser premium being payable.

Option 2: Basic Hospital Option

Entry level Premium: *R950 p/m

*Rate for single individual at date of publication.

This option only covers in-hospital treatment costs.

NOTE:

• No cover is provided for GP and dentist visits or prescription medicines.
• You may have shortfalls in cover if specialists charge more than the medical aid rate. Gap cover is advisable to cover these shortfalls along with any co-payments that may be charged.

Option 3: Hospital Option with Savings

Entry level Premium: *R1850 p/m

*Rate for single individual at date of publication.

• This option covers in-hospital treatment costs and also provides a Medical Aid Savings Account. The Medical Savings Account will cover day-to-day expenses for GP, Dentist visits and medications. A fixed monthly contribution is payable to the Medical Aid Savings Account with a total annual limit amount available in advance. Depletion of the Medical Aid Savings Account balance means that you will be liable for day-to-day treatment costs.

NOTE:

• You may have shortfalls in cover if specialists charge more than the medical aid rate. Gap cover is advisable to cover these shortfalls along with any co-payments.

Option 4: Comprehensive Option

Entry level Premium: *R3140 p/m

*Rate for single individual  at date of publication

This option will cover almost all day-to-day and in-hospital medical expenses.

NOTE:

• You can also have a medical aid savings account with this plan.
• These plans are more expensive but provide comprehensive cover in and out of hospital.  
• You may have shortfalls in cover if specialists charge more than the medical aid rate. Gap cover is advisable to cover these shortfalls along with any co-payments that may be charged.

 

Contact HealthMax today to determine the medical aid option and medical aid provider that will best suit your unique healthcare needs.

 

The information contained in this communication, including attachments, is not to be construed as advice in terms of the Financial Advisory and Intermediary Services Act of 2002 (“FAIS”) as the writer is neither an appointed representative of Zestlife, nor a licensed financial services provider as contemplated in FAIS. Please consult your Financial Adviser or Zestlife should you require advice of a financial nature and/or intermediary services.