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What you didn’t know about medical schemes in South Africa

Article provided by Medshield

South African medical aid schemes play an important role in the healthcare industry of the country. Without medical aids, many South Africans will not able to afford the quality healthcare that private medical practitioners and hospitals provide. It is certainly in your best interest to belong to an affordable South African medical aid scheme, especially if you or one of your dependants suffers from a chronic health condition. Here are some facts that you may not have known, about South African medical schemes.

Two types of medical aid schemes operate in the country. The one type is restricted in membership. This means that only the members of a particular organisation can belong to this medical scheme. This is called a ‘closed’ medical scheme.

The other type is open in nature, meaning that anyone can join, and is known as an ‘open’ medical scheme.

The Council for Medical Schemes (CMS) oversees and governs the medical aid industry in the country. All medical aids must operate according to the regulations of the Medical Schemes Act of 1998. This also means that every scheme must provide cover to its members for the prescribed list of 27 chronic medical conditions and all the conditions listed under Prescribed Minimum Benefits or PMBs.

You may only belong to one medical aid at a time and may be required to meet specific minimum conditions before you can make use of the benefits that the scheme offers. The older you are when you join a South African medical aid scheme for the first time, the higher your premiums will be. It is thus to your benefit to become a member as soon as possible.

The law requires that a medical aid has to keep a quarter (25%) of their assets in reserve, ensuring stability of the scheme. If you are looking to join a medical scheme, look for a stable company with a high solvency ratio and proven record of responsible membership contribution management.

Most of the reputable medical schemes structure their benefit plans to meet the healthcare needs and budget requirements of members, and offer a wide range of plans. In addition, they provide add-on services, such as the preventative healthcare plans in which members have access to tests, vaccinations, and screenings at relevant service providers. Affordability of their membership contributions, in addition to a strong focus on responsible spending of funds to ensure relevancy of services and products are also some of the criteria when choosing a medical aid provider.

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