How To Choose A Medical Aid

How do I choose a medical aid?


It is a well-known fact that medical cover does not come cheap, so making the right decision at the outset is very important.

There are several factors to take into consideration before selecting medical aid cover.

Do you need medical aid or just a hospital plan?

  • Hospital Plans


This can be a tricky decision and is often weighted by an affordability scale.

Hospital plans are more affordable because while the cover is basic, it nevertheless pays for important medical hospital procedures and follow-up examinations.

Bear in mind that hospital plans do not cover day-to-day medical needs, such as visits to the doctor and dentist, or medication.

  • Medical Aid


Choose A Medical AidPeople with a poor health track record, or who suffer from dental and vision problems, will need better medical cover.

However, monthly premiums for medical aid can run into the thousands, so ensure affordability before making this important decision.

Also, check the different scales of benefits and exclusions, as well as the cost, of the various medical schemes available to the South African public.

Track record

When opting for medical aid, investigate the track record of the company selected.

This can easily be done by asking your local GP or hospital if they have ever had problems receiving payments from the medical scheme of your choice.


It is vitally important to ascertain the solvency of the medical scheme of your choice.

This is not a difficult exercise and can be disclosed via online research or an insurance broker.

In terms of the law, South African medical schemes must retain at least 25% of their members’ premium payments to ensure that they can meet claims lodged for medical bills throughout the year.


Exclusions built into medical cover policies can be a minefield for the unsuspecting client.

Examples of exclusions are:

  • A 12-month waiting period for people with pre-existing medical conditions
  • A three-month waiting after joining a scheme before qualifying for any benefits
  • Non-payment for HIV sufferers
  • Non-payment or severe financial limitations for cancer patients


Other pitfalls – Choose A Medical Aid

There are many pitfalls with medical aid cover that can have a crippling financial impact on policyholders.

Among these are:

  • 100% cover – medical schemes work on a tariff rate that, more often than not, is 500% less than what medical professionals and private hospitals charge for their services
  • Medical Savings Accounts – check daily limits, because if annual funds allocated for various medical needs dry out months before the time, the policyholder is left to foot the bill
  • Co-payments – these are the amounts of cash policyholders have to pay upfront for medical procedures and hospital admissions
  • Annual hospital limitations – for example, a medical scheme could limit payouts for hospitalisation to R500 000 per family annually which could be hopelessly too little to meet final bills from the medical profession


Conclusion – Choose A Medical Aid

Joining a medical scheme is a major financial commitment.

So it is always wise to consult a reputable independent broker for unbiased advice.

All info was correct at time of publishing