How to choose a medical scheme

You’ve made the decision to get medical cover but with close to 100 different options in the country, the task can feel daunting. You need to arm yourself with the right knowledge and then you can choose a medical scheme that will best suit you and, if applicable, your dependents.


Analyse your financial situation

The first step is to analyse your financial situation and your medical health and use this data to help you make an informed choice. If you are in a secure financial position and you can afford full medical cover, then this is the recommended option as it gives you peace of mind.

It demands a sizeable portion of your monthly income, so it’s imperative that you know precisely what your regular contributions will be, to see if you can afford it.

This comprehensive insurance is preferred by the elderly, or those who make regular hospital or doctor visits, and it’s essential if you suffer from a chronic medical condition.

This type of medical aid is expensive and it’s therefore out of reach for many South Africans and so an alternative choice is to have a hospital plan. With this route the member is responsible for their daily

How to Choose a Medical Scheme

medical costs and so if you are in good health and visit the doctor infrequently it can be significantly cheaper than full cover. This option is favoured by younger, healthier individuals.


Compare different options

Once you’ve decided which type of health insurance you want, you should compare different companies and the benefits that they offer. Ensure that the Prescribed Minimum Benefits are adhered to.

Before you choose a medical scheme you should also find out if there are penalties or exclusions.

There may be a late joiner penalty or an enforced waiting period where you’ll be paying a monthly contribution but will not be allowed to claim benefits.



Just as health insurance companies scrutinise each member’s application before allowing them to join, a person looking for medical cover needs to be just as thorough.

According to the law, these companies need to have a reserve of 25% of members’ yearly contributions and if they don’t you could face higher monthly fees or reduced benefits. You can request this solvency ratio from a broker.

You should also investigate the company’s growth rate because if there are no new members joining up then the old members are burdened with higher premiums to cover increasing costs.


The medical institution

You want your medical institution to be financially sound and you can confirm this by contacting a private hospital and inquiring about their payment record. What you’re also looking for is good service levels and this is shown by how swiftly members or providers are paid out for claims.

If you’re still daunted by your options you can enlist the services of an accredited broker to help you choose a medical scheme.

Their advice is impartial and they will help you to select an affordable health care plan that most suits and benefits you. This is an important decision and you need to make a comprehensive and thorough investigation of your options before you sign on the dotted line.