Question

I would like to join a medical aid after not being on one for the past two years.  I’m 39 with a young child and can only pay around R3 500 a month. I’m looking for the following:

• comprehensive hospital cover
• sufficient day-to-day savings
• GP visits
• dental cover
• mental health benefits

In addition, I would like to have my hearing aid covered and be able to join a gym at a discount.

Answer

Over the past year, the premiums for medical aids increased by way more than the inflation rate.  The R3 500 budget will be a challenge, especially after the recent increases. We need to find a solution where we can get you most of these benefits you need on your available budget

The old style medical aids that offered unlimited visits to hospitals, doctors and dentists no longer exist.  There will be out of pocket expenses. At the risk of oversimplifying a complex industry, what you have now is

• a core of medical cover that will pay out if you need to claim against a prescribed medical benefit. These are the 271 defined diagnoses and 27 chronic diseases that all medical schemes must pay for
• the payment of a percentage (usually between 100% and 300%) of your costs when you are in hospital.
• other expenses paid by yourself or some kind of medical savings account.

Most medical aids offer an entry level scheme where the premiums are lower, but you are restricted in terms of what hospitals you may stay at, the doctors you may use and where you make collect any chronic medication.  If you use providers that are outside of this network, then you will have to make a copayment.

What I would recommend is that you look at the networks that are offered for the entry level schemes of the different medical aids and see if the hospitals and doctors that are part of the network are close you. Each medical aid has a different panel so look for the medical aid that can provide you with the hospitals and doctors that are closest.

With the entry level scheme, the visits to the doctors and dentists will require a small copayment each time you visit them.  The benefit does not cover specialised dentistry so you would need to make allowances for that in your budget.

I have not found an entry level team that covers hearing aids so you would need to budget for that separately. 

If the mental health condition is classed as a prescribed minimum benefit, then it would be covered by the entry level scheme with certain limitations regarding in-hospital and out of hospital benefits.

Most of the medical aids have some kind of scheme that encourages you to keep healthy. You should be able to find an entry level scheme that will also allow you to get a discount on a gym membership.

I would recommend that you contact a medical aid broker who can compare the options of the different medical aids.  You would need to find the scheme that offers the most convenient network of medical suppliers at the right price.  There will be compromises that will have to be made and it is important that your choices are informed.

Insider tip

If you change cities, remember to check that the network of medical providers that you are linked to is still the most appropriate one. You do not want to be in a situation where you have to drive 30 kilometers to the nearest medical practitioner on the panel.