Discover Medical Aid - What Is It?

Discover Medical Aid where you get the best cover for your money.

What is a Medical Aid

Medical aid is where contributions are paid to medical aid schemes and are pooled and safeguarded. These schemes are operated on a not-for-profit basis. Medical aid covers members' healthcare costs such as hospitalization, treatments, and medicine. These costs are covered according to the rules of the medical scheme and the member’s medical aid plan type. These rules ensure that members are fairly cared for. All medical schemes in South Africa are governed in accordance with the Medical Schemes Act 131 of 1998 and are regulated by the Council of Medical Schemes

Discover Medical Aid to choose and why you need it

Everyone needs some form of medical aid cover. Few of us could afford the costs of long hospital stays or care for serious injuries, surgery, or chronic illnesses – for example, it costs R8 500 a night for a premature baby to stay in a private hospital’s neonatal unit (some stay for five months), and that’s just the bed, without any consultations, medicine or medical supplies. Medical schemes help us finance life’s curved balls when we can’t do it alone. Discover Medical Aid, that can help you with that.

It’s advisable to evaluate your medical aid coverage each year to make sure you have adequate cover for your needs or for any changes in your health, for example, deciding to have a child or being diagnosed with a chronic condition.

More importantly, traumatic events like a car accident, crime-related incidents or sport-related incidents can happen to anyone at any age or life stage. The costs associated with one of these random, high-risk events can run into many thousands or even hundreds of thousands of rands, which few people can afford at any life stage – especially when you’re young.

And if you want choose the best medical aid for yourself here are some tips to follow.

1. Work out your budget

Discover Medical Aid where your medical aid contribution does not exceed 10% of you monthly income. Drawing up your monthly budget will help you to determine how much you can afford. The good news is that hospital plans can be very affordable and if you do not yet have a family and are an up-and-coming professional, this may be all you need. As your career progresses and your lifestyle needs change, you can move to a more comprehensive plan. The important thing is to join a medical scheme as soon as possible. Anyone joining a medical scheme for the first time after the age of 35 will be penalised with higher fees for the rest of their lives

2. What is your needs

Budget is important, but so are your health needs. If you are young, healthy, and independent, a hospital plan is an excellent and affordable way to join a medical scheme. However, if you are a parent or have a chronic illness, more comprehensive cover is the way to go. Most medical schemes offer a variety of benefit options, beginning with basic hospital cover and then adding different benefits. If a plan works with a network of hospitals there are also savings, provided you choose to go to a networked service provider.

3. Ensure value for money and what is your co-payment amount

Assessing medical schemes and member benefits is about more than what premiums cost – Discover Medical Aid where it’s about what your premium gets you in terms of value for money. For example, some medical schemes manage their costs (and can therefore offer lower premiums) by limiting pay-outs on certain costly procedures, such as elective joint replacement procedures and even certain cancer treatments. Be careful not to choose a scheme based on price alone. Be aware of your chosen benefit option’s limitations. Also make sure you investigate any other conditions of the scheme such as waiting periods on pre-existing health conditions.

Most medical aid plans have defined co-payments and sub-limits which means as a member you will need to pay the difference between what the medical aid covers (medical aid rates) and what the hospital and specialists charge. At Profmed, we have contracted with networked hospitals to reduce these co-payments. All of our Savvy options work with networked hospitals which reduces co-payments. In general, more affordable benefits generally require higher co-payments for specialists and hospital procedures, however. If you do not currently have any specialist medical needs a hospital plan or entry-level benefit plan could be perfect, and you could move to a more comprehensive plan as your needs change (thereby lowering your co-payments). All schemes have some co-payments in place, so just be aware of them and how they work so that you aren’t caught unaware.