Medical insurance: Selecting the right cover at the right price

The announcement by several of the country’s largest medical schemes of above inflationary increases for 2019 has left many already cash-strapped South Africans considering their options when it comes to insuring their health.


One of the key contributors to healthcare inflation is the rise in people suffering from non-communicable diseases (NCD), like heart disease, stroke, cancer, diabetes and chronic respiratory disease. According to the World Health Organisation (WHO),  71% of all deaths are caused by NCDs and while this puts pressure on health budgets the world over, it is lower and middle income countries like South Africa who bear the brunt of this burden due to people living longer and the increase in urbanisation and industrialisation. As public health budgets become squeezed, so do the resources that should be allocated to preventing and treating these diseases before they become life-threatening, often leaving patients without the care they need. 


Stats SA’s General Household Survey, estimates that only 17 in 100 South Africans have medical insurance, affording them access to private healthcare. This means that by far the majority of South Africans are dependent on an over-burdened state sector for their healthcare needs.


Vera Nagtegaal, executive head of, says that the recently released White Paper relating to the proposed National Health Insurance provides the promise of a health system based on primary and preventative care where access to quality services will be free at the point of service.


“Although the NHI provides hope for future access to affordable, quality healthcare, the system is only expected to become a reality in 2022 or beyond.  In the meanwhile, it is important to ensure that you and your family have access to primary and preventative care,” she says.


The Council for Medical Schemes Annual Report shows a decrease in the number of dependent members on open medical schemes. This may mean that where a family’s budget does not allow for the entire family to be covered by medical aid they are electing for just the main member to remain on the scheme.


Nagtegaal cautions those who are considering opting out of their medical insurance to think twice about their decision and to rather consider other, lower cost alternatives that will still provide access to private healthcare.


“Buying down to a lower cost option within a medical scheme is one solution. Apart from providing cover for accidents and illnesses requiring hospitalisation, these options must, by law, also provide benefits for 25 of the most common chronic conditions, including high blood pressure, diabetes and heart disease,” she explains.


Medical insurance products provide yet another alternative. These products are often less expensive than medical aids and mostly provide cover for day-to-day healthcare needs, like GP visits, basic dentistry and optometry.


“Although most medical insurance products offer limited hospital cover, they could be a good alternative for accessing day-to-day cover in the private sector, depending on the cover you choose,” Nagtegaal points out.


But, whether you are on a medical scheme and considering your options, or you rely on the state sector and would like access to the private health sector, she says that it is important to be sure to find the cover that adds the most value to you at a premium that fits with your budget. 


“Secondly, help yourself and your family to minimise the risk of chronic disease by following a healthy lifestyle” she adds.

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