The Ultimate guide to Medical Aid Cover in 2020

Medical Aid Cover in 2020 from small visits to the doctor to an appendectomy, medical costs can be crippling, especially in emergency situations. When you don’t have the right cover you don’t have access to crucial funds for you and your family, and these costs often lead to unnecessary financial stress. we will get your medical aid quotes in a flash, and you can enjoy peace of mind knowing that you have the right medical cover.

Medical aid for students

Medical Aid for Students offers financial cover for health-related expenses at an affordable price for those who have become too old to stay on their parent’s policy but are not yet permanently employed and are still studying at a tertiary institution. Proof of enrolment at an institution will qualify you for reduced rates.

A Hospital Plan that covers mainly in-hospital costs is the most popular choice for students who are relatively healthy, but would like the assurance that they are covered financially should they require hospital admission. A comprehensive Medical Aid plan is still an option though, if the funds are available, for students who have a chronic condition. Cost-effective plans that offer both in- and out-of-hospital cover are also available based on your individual needs.

If you are 21 years of age or younger, you are allowed to be a dependant on your parent’s Medical Aid and will be charged the child rate. Certain Medical Aids allow you to continue paying the child rate up to age 26 provided you can present proof of full-time studies.

Medical aid for pregnant women

Medical schemes offer comprehensive or hospital plan cover to expecting moms to provide for their medical needs. If you have comprehensive cover, your essential antenatal consultations, as well as in-hospital childbirth, are covered, whereas if you have a hospital plan you will need to cover the costs of any out-of-hospital expenses. It is important to find the best value for your requirements. Look for the best benefits at the lowest price, without compromising quality. This is why it is helpful to compare Medical Aid quotes from a range of different providers.

Having a comprehensive Medical Aid plan will ensure that your consultations pre and post-birth, as well as the birth itself, is covered. Depending on the scheme, the full rate for any specialist consultation may not be covered, in which case you will have to pay the difference yourself. Having a hospital plan will ensure that your in-hospital childbirth is covered but you will have to pay for any out-of-hospital expenses.

Depending on your chosen Medical Aid plan, your newborn will automatically be covered upon their birth as long as you inform the Medical Aid and complete the relevant forms as soon as possible for them to adjust your rates.

What happens if you’re pregnant and you don’t have a comprehensive cover or a hospital plan?

While a medical scheme cannot refuse to accept a pregnant woman who applies for cover, the current pregnancy and childbirth won’t be covered. This is why it’s always best to take out Medical Aid while you’re still young and healthy and are able to contribute enough to your policy so that when you fall pregnant, you are well and truly covered. Compare quotes online to find the best policy to suit your needs.

Medical aid for pensioners

Medical Aid for Pensioners offers financial cover for health-related expenses specifically for those at the stage of retirement. Medical Aid schemes in South Africa do not have an age restriction, but a fee does apply if you start your cover for the first time after the age of 35. Medical Aid for people of pension age can be difficult to compare. Often, as people reach retirement age, their disposable income decreases, but their health risks increase. That is why it is always best to get advice from a professional financial advisor or Medical Aid broker.

Advantages and disadvantages

As a pensioner whose budget is tight but whose medical expenses are expected to increase due to their age, it is vitally important to note that there are options available to suit their budget and their medical needs. Pensioners could benefit from considering Medical Aid plans that include comprehensive in-hospital cover in case of medical emergencies, day-to-day cover for GP visits and medication, as well as dentistry and optometry.

But, if you have never signed up for Medical Aid before, and you’re of pensioner age, you will have to pay a late joiner penalty fee that can increase your monthly premiums by up to 75%. This fee is dependent on age, so someone who is 60 will pay less of a penalty fee than someone who is 80, for example.

Depending on previous Medical Aid cover, all medical aids are entitled to impose a 3 month general waiting period, during which no claims will be paid, and / or a 12 month exclusion for any pre-existing medical conditions.

If you have yet to invest in Medical Aid, or have decided to take out a new policy, it’s best to do your research before you apply.

Medical aid for families

Family Medical Aid is an important financial investment to consider for new and potential parents. This type of policy covers a family financially for day-to-day and in-hospital health-related expenses. The bulk of the premium is applied to the main member while smaller amounts are added for each dependant such as a spouse and children.

Questions to ask your potential Medical Aid scheme

  • What are the benefits for the main member?
  • Are the benefits the same for both the main member and their dependents?
  • Will costs increase for the main member if they’re planning on extending their family?
  • Will costs increase when the child dependants reach a specific age?
  • How much day-to-day cover will the family receive annually?

These questions are vital to ask before choosing a family Medical Aid plan so that you can budget for the day-to-day expenses for the year ahead. And, if you are planning on starting a family soon, these questions will help you figure out whether prenatal and postnatal care, the birth, pediatric consultations, and vaccinations are covered, and what the procedure is for registering your newborn on your plan.

Medical aid for children

Medical Aid schemes in South Africa do not allow children under the age of 18 to be the main members on a Medical Aid, but rather a dependant on an adult’s scheme that covers their health-related expenses. There are certain situations that make an exception to this rule, such as if the parent or guardian is deceased and there are sufficient resources from their estate to keep the child’s membership going.

Benefits suited for dependant children

If you are looking at adding your child or newborn to your Medical Aid plan, there are certain benefits that are good to have in place. Ideally, you’d like to have comprehensive in-hospital cover in case of medical emergencies, day-to-day cover for pediatrician visits and medication, as well as basic dentistry and optometry. It is important to look for the best benefits at the lowest price, without compromising quality.

Speak to your Medical Aid broker in order to discuss your family’s specific medical needs as they should be able to give advice on the benefits you would need and help you decide on the best option for your family. It’s also helpful to compare Medical Aid quotes from a range of different providers in order to find the best value for your requirements.

Medical Insurance vs Medical Aid

Many people question whether they should get Medical Insurance because of the higher costs incurred by a Medical Aid. While their costs differ, it’s because they offer different services and benefits. The plan you inevitably choose depends on your life stage, lifestyle and needs.

What is the difference between Medical Insurance and Medical Aid?

Medical Aid and Medical Insurance are two different products. Medical Aid provides in-hospital cover and pays for treatment according to the specific medical scheme tariff. Medical Insurance, however, traditionally pays out a set amount for each day spent in hospital or a set maximum amount per incident, regardless of the type of treatment that’s required. Medical Insurance can be taken out as a stand-alone product or can be used as a top-up product for when your Medical Aid savings have run out.

With Medical Aid, payment for medical treatment is usually made directly to the hospital and/or service providers. With Medical Insurance, payment is usually made directly to you and you must settle your own accounts. The reimbursement can be used to pay for the cost of medical treatment or to pay for other daily expenses incurred whilst in hospital.

Both Medical Aid and Medical Insurance can provide cover for day-to-day medical expenses such as GP visits and medication. Medical Insurance usually offers limited cover for these day-to-day costs, and you will have to cover most of these medical expenses yourself. With Medical Aid, you have far more cover and benefits when it comes to day-to-day health appointments and medication, depending on the option that you choose. Some providers will expect you to pay for the day-to-day benefits yourself and then claim them back from your Medical Aid.

Another difference between Medical Insurance and Medical Aid is cost. The cost to take out Medical Insurance is lower than that of Medical Aid because it offers fewer benefits. The best way to decide which plan is right for you is to assess your medical needs. If you’re generally healthy and unlikely to incur ongoing day-to-day medical costs, then Medical Insurance might be adequate for you. If you are older and prone to health issues, a Medical Aid might be a better fit. Once you’ve worked out these needs, you can compare quotes and benefits online to find a plan to best suit your needs.


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