Question 1

How does Medical Aid work?

Accepted Answer

It operates as a mutual benefit system where members pay a monthly premium into a collective fund. This pooled fund pays for members' expenses according to the benefits and limits of their chosen plan. Surplus funds are transferred to scheme reserves for the benefit of all members. Depending on your cover type, you may access a personal savings account for day-to-day cover or pay some costs out of pocket once your limits are reached. By law, all registered Medical Aid plans must cover emergency medical conditions, 271 conditions and 27 chronic diseases - known as Prescribed Minimum Benefits (PMBs). New members may be subject to a 3-month general waiting period and up to 12 months for pre-existing conditions. Plans vary in cost and benefits, allowing you to choose a level of support that suits your health needs and budget.

Question 2

How much does it cost in South Africa?

Accepted Answer

Costs vary widely depending on the level of cover you need. Comprehensive plans with day-to-day benefits and hospital cover carry higher premiums, while more affordable options like hospital or network plans suit those on tighter budgets. Monthly premiums for entry-level hospital plans can range from +/-R1,000pm to several thousand Rand for savings and comprehensive plans. Note that higher premiums may apply if you join a scheme for the first time after age 35. Use Hippo to compare quotes and find a plan that balances cover and affordability.

Question 3

What's the difference between Medical Aid and Gap Cover?

Accepted Answer

Medical Aid includes GP visits, hospital stays, chronic medicine and more, with all registered schemes required to provide PMBs. Gap Cover is a separate policy that works alongside your scheme. When healthcare providers charge more than your scheme's set tariff, Gap Cover pays the difference; protecting members from unexpected out-of-pocket claims. It's a valuable add-on for greater peace of mind, not a replacement for your scheme.

Question 4

What is the best option for a family?

Accepted Answer

The right plan for your family depends on your unique health needs and budget. If your family needs all-round cover, including day-to-day benefits and hospital access, a comprehensive plan may suit you best. If affordability is the priority and you mainly need protection for hospital stays, a hospital plan offers a cost-effective solution. The happy-medium option is a savings plan, allowing for in-hospital cover and a savings account contribution for day-to-day medical expenses. Compare options side by side on Hippo to find the right fit for your family.

Question 5

How do I cancel my plan?

Accepted Answer

Review your contract terms, most schemes require a notice period. Submit a written cancellation request to your provider, settle any outstanding payments and ensure there's no gap in cover if you're switching. Before cancelling, compare quotes from other providers on Hippo, you may find a scheme that better suits your current budget.

Question 6

What scheme is the best?

Accepted Answer

There's no single answer; it depends on your health needs, lifestyle and budget. The best way to choose is to compare options from multiple schemes and weigh the benefits, exclusions and costs.

Question 7

What's the difference between a scheme and medical insurance?

Accepted Answer

A Medical Aid scheme is a non-profit, pool-based healthcare funding system covering hospitalisation, doctor's visits, specialist care and more. Medical Insurance offers fixed benefit payouts for specific events or conditions and generally provides less comprehensive cover.

Question 8

How do I know if a medical scheme is financially sound?

Accepted Answer

There are two indicators that tell you whether a Medical Aid scheme is in a strong financial position: its solvency ratio and its Global Credit Rating (GCR). The solvency ratio measures whether a scheme has enough assets to cover its long-term liabilities and future claims. South African law requires all registered medical aid schemes to maintain a minimum solvency level of 25%, as stipulated in Regulation 29 of the Medical Schemes Act. A GCR rating reflects a scheme's overall financial stability and its ability to meet its financial obligations, with ratings running from AAA at the top down to CCC. When comparing Medical Aid options, check both figures, a scheme that meets its legal solvency requirements and holds a strong GCR rating is better placed to pay claims reliably, now and in the future.

Question 9

How will the NHI affect cover?

Accepted Answer

The National Health Insurance (NHI) aims to provide universal healthcare access to all South Africans, but the rollout is still in progress. Once fully implemented, the NHI may limit private schemes to covering services not provided by the state. For now, schemes remain essential for accessing private hospital care, avoiding long queues and getting faster treatment.

No posts to show