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5 Myths about medical aid schemes in South Africa

Article provided by Medshield Medical Scheme

At any get-together or party, someone is bound to bring up topics such as politics, insurance, and medical aid schemes. South Africa has a few major private healthcare medical schemes that have remained popular for the last few decades. To make comprehensive coverage both affordable and easy to understand, we include 5 myths about medical schemes in South Africa below:

Myth 1: Only wealthy people can afford healthcare cover

Public healthcare in South Africa indeed has a poor reputation, and many who end up in state-funded hospitals and clinics would certainly prefer private healthcare. While premium, comprehensive benefit cover options or plans do cost more, certain options such as hospital plans and digital options are affordable, especially if you consider that it is your health on the line.

Myth 2: Medical aid schemes reject some applications

In South Africa, no applications for medical aid can be turned down. While late-joiner penalties, exclusions and a three-month or 12-month waiting period may apply, your application will be approved if you are able to pay the monthly membership contribution. No matter your current health status, it is always best to seek quality coverage.

Myth 3: 100% Cover means no out-of-pocket payments

100% cover simply means that the scheme covers you for 100% of the medical aid fund tariff. This tariff is often far lower than the actual cost of your specialist or hospital fees. This difference in fees can be remedied with an out-of-pocket co-payment, gap cover, or medical savings options offered by some schemes. If you foresee a future operation or treatment, speak to your specialist about what the charge will be for the procedure and compare this to what rate your scheme covers.

Myth 4: Medical aid schemes hardly ever pay out

Another misconception is that every scheme is a scam or trick to swindle members out of their money. According to legal regulations, however, a scheme has to pay out within 30 days from the date they receive a claim. Members who feel done in by their scheme often do not understand what their chosen plans entail, such as benefit cover rates and benefit limits.

Myth 5: All medical aids are the same

Functionally, they are all the same in that they are non-profit institutions run by their own trustees. However, they do not all have the same plans and benefits available. Product offerings usually vary as any scheme is free to target whichever demographic they see fit.

Medshield Medical Scheme is a proud Partner of the NSBC