Medical Schemes Do Well Despite Few New Members

If your place of employment provides medical aid cover for you,  good and well. But these days, many South Africans are holding off joining  a medical scheme because they can’t afford it. But they should, because medical schemes do well in SA.

People believe that even with medical scheme membership they will have to pay out-of-pocket for doctor visits, medicines and treatments.

The aim of he medical scheme is to help their members access health care services. They will pay medical rates  as they appear by the rules of the scheme.

For many medical aid members, it doesn’t help to tell them that the National Health Reference Price List (NHRPL) for health services is what healthcare service providers follow as a guideline to bill for consultations and procedures.

Members believe that because they pay such high medical aid premiums, they should have total,  100% cover.

Waiting Periods and Exclusions mean More Money for Medical Schemes

Medical Schemes Do Well in South AfricaPrivate health insurance is supposed to protect members from the high costs of medical care. But it doesn’t because there are all kinds of exclusions, waiting periods and limitations imposed. Hikes in healthcare costs and higher than general inflation costs are meaning higher subscription rates increasing every year for members.  Medical aid members just feel they are accepting unfair terms when joining a new scheme. And they feel they are losing out while the medical aids are getting richer.

Medical scheme membership is more or less income-related. And this means that many South Africans can’t join a medical scheme. That is, unless their employers assist with part-payment. The cost of living is so high in South Africa that even high income earners are thinking twice about joining a medical scheme. They have to think of their other seriously high consumption priorities like paying off a home, a car and school fees.

Medical Schemes Score with Late Joiner Penalty Fees

Even though fewer people are joining medical schemes, still the medical schemes do well and are financially healthy. For starters, South African medical aid schemes inflate their funds by imposing all kinds of penalties on individuals who do decide to join a medical aid later on in life. Yes, a medical scheme can’t refuse to take you on as a member in South Africa, but they impose a late joiner penalty.

These penalties for late joiners will depend on factors such as the age of the member, the number of years they have been a member of a medical scheme and also the number of years the person had no cover at all.

Medical schemes don’t always pay medical fees for patients in full, and the difference or shortfall is for patients to pay out of their own pockets. They have to cough up for hospital stays or specialists who charge more for their services than what the medical aid is prepared to pay.

Medical Schemes Do Well – You Pay – but You’re Limited

Medical aids are healthy too because they have limits – overall limits or limits in certain categories. This means that no matter how ill you are, there is a maximum that a member and his dependents can spend in the year. If a medical scheme for instance covers 80% of the NRPL rate of a visit to the GP, then the  the remaining 20% will have to be paid by the member.

In spite of less members joining medical aids schemes in South Africa, they are as healthy as ever. South Africans are fed up with the profound complexities within medical scheme structures, preferring to look at other options. The exclusions and waiting periods are just too difficult for consumers to comprehend so they are making decisions for other options, realizing that medical aids are in many instances not meeting their needs.


All info was correct at time of publishing