What is a Medical Scheme?

The cost of medical treatment has skyrocketed and anybody that faces a serious condition that requires on going specialist treatment or major surgical procedures stand in danger of financial ruin if there is no medical aid to help carry the cost.

And this is the short answer to the question: “What is a medical scheme?”

Medical aid schemes are there to help people afford the best possible medical care.

What is a medical scheme?

How does it work? A medical scheme is a non-profit company that requires compliance to a special set of rules and criteria. Their main business is to accept liability for the medical costs of their members in exchange for a regular contribution.

The most important of these criteria are as follows:

  • They must be able to prove that they are financially healthy enough to provide the benefits that they have promised to their members
  • They may not discriminate against any person or group
  • At least half of the members of the board of trustees tasked with managing the scheme must also be members of the scheme itself

How to choose a scheme Medical aid in South Africa can be extremely expensive and it is certainly worth What is a medical schemeit to conduct thorough research before joining a specific scheme.

Some of the most important aspects to consider when examining the various options are as follows:

  • Not all schemes offer the same benefits. It is vital to study the benefits as well as the terms and conditions and to ask questions from the scheme if there is even the slightest uncertainty.
  • It may be wisest to consider only schemes that are flexible and that can be adjusted as circumstances change.
  • Many employers are willing to make a contribution on behalf of employees only if the employee becomes a member of the scheme supported by the employer. Employees have the right to negotiate this matter with employers, especially if they are already members of another scheme.
  • The cost of membership is important to most people but this should not be the most important factor when making a final decision. Affordable medical aid is not always what it seems. If the benefits offered will not meet the medical requirements of the members, then membership should be reconsidered. Many schemes offer very limited cover and it is vital to buy the best cover that can be afforded.
  • It is also important to know one’s rights in terms of the laws governing these schemes. There are certain conditions that simply have to be covered. There are Prescribed Minimum Benefits that must be part of each and every membership. These conditions must be covered in full by the scheme with the proviso that the scheme may appoint designated service providers. Is it really important?

Some people see membership of a scheme as an onerous expense but perhaps one should get back to the original question: What is a medical scheme? The answer is simple: it is a safety net that is there when calamity strikes. Nobody wants inferior treatment when their lives or the lives of their loved ones are in danger. With full cover one can rest assure that the very best treatment by the very best specialists will be available when it is needed most.

Read this article: Top 10 Important Facts About South African Medical Aids