How to Get the most out of your medical aid plan

Private healthcare in South Africa can be quite costly, which is why many people choose to belong to a reputable medical aid service provider or have a health insurance policy. Discover more about your medical aid plan and how to get the most out of it as Bloom discusses this in more detail.

What is a medical aid plan?

A medical aid plan is registered with the Registrar of Medical Schemes. Members make a monthly contribution to the scheme in exchange for a set of prescribed minimum benefits (PMB’s).

Prescribed minimum benefits are a feature of the Medical Schemes Act and are applied to ensure that all medical scheme members will have access to certain minimum health services, regardless of their selected benefit options. These apply to the diagnosis, treatment and care of the following:

  • Emergency medical condition
  • A set of 271 medical conditions as defined in the Diagnosis Treatment Pairs
  • A list of 26 chronic conditions as outlined in the Chronic Disease List
When you sign up for medical aid, you should be mindful of the fact that medical aid plans usually have a waiting period of up to three months with a claims exclusion period of up to 12 months for a pre-existing condition.

Benefits of a medical aid plan

There are a number of reasons to ensure you’re covered by a medical aid plan. Some of these include the advantage of: 

  • Being financially protected against large or unexpected medical costs
  • Having access to private health services and treatment
  • Having access to private hospitals
  • Getting tax rebates

Key features of a medical aid plan

  • It’s governed by The Council of Medical Schemes and The South African Medical Schemes Act
  • Medical cover is based on the medical scheme tariff
  • Payments are made directly to the healthcare service provider or practitioner
  • There are fixed monthly subscription fees
  • There are standardised prescribed minimum benefits
  • Medical aid does not include additional benefits
  • There is a waiting period for the overall medical aid cover
  • If there is a shortfall, the member will be required to cover the costs out-of-pocket or through additional medical cover, like GAP Insurance

How to get the most out of your medical aid plan

Be smart when you get a medical aid plan. Be mindful of the following factors,  or take advantage of these perks, in order to make sure you’re getting value for money:

  • Only use doctors and healthcare service providers who are part of the scheme’s medical aid network so that they charge medical aid rates.
  • Opt for generic medication, which is cheaper than the branded version and is still covered by a medical aid plan
  • Get a referral letter from a GP before you visit a specialist. This ensures your claim won’t be rejected.
  • Use the medical aid’s chosen network of service providers like hospitals, GPs, specialists and pharmacies. Only authorised healthcare professionals or services will be covered by your medical aid plan. Plus the medical aid scheme will have negotiated favourable rates with these networks, which could save you money.
  • Register for chronic medication. Your GP will need to complete forms about your chronic condition, like diabetes or high blood pressure, and will send the documents to your medical aid service provider for authorisation. If you don’t register, the cost will be deducted from your day-to-day expenses as opposed to your medical aid funds.
  • Settle your bill with the medical practitioner and claim back from medical aid. Some healthcare practitioners and pharmacies will apply a premium on the transaction as well as a handling fee. This will be deducted from your medical savings.
  • Reduce your risk of getting ill, especially preventable diseases, like colds and flu, by living a healthy lifestyle. Exercise, stick to a nutritious diet plan and get those screenings, medical check-ups and flu shots.
  • Choose the medical aid plan that works best for you based on your age, gender, health, individual healthcare needs, day-to-day requirements and budget.
  • Educate yourself and be aware of your personal healthcare risks based on lifestyle and family medical history.
  • Disclose any pre-existing conditions when applying for medical aid. This will avoid claim rejection if you failed to disclose the particulars of your condition.
  • Study your medical aid plan. Read the fine print. Find out what it covers and what it doesn’t cover. It also helps to be aware of exclusions, limitations and waiting periods.
  • Use the loyalty programmes or perks that may come with your particular plan. These could vary from one medical scheme to the next but there are often discounts or cash-back benefits on retail items, travel and others.
  • Get medical aid when you’re young. Don’t be a late joiner, which is a member over the age of 35 who has never previously belonged to any sort of medical aid scheme. A late joiner will have higher monthly premiums than members who signed up earlier.
  • Downgrade your plan. If you’re battling to afford the monthly premiums, consider downgrading your medical aid plan, rather than just cancelling it altogether as this will leave you vulnerable if you need healthcare services.
  • Get professional help. If you’re unsure about any aspect of your medical aid plan, contact your service provider and speak to a consultant who can explain the process, plan or particulars to you.

Get a medical aid plan from Bloom

Whether you’ve opted for medical aid or health insurance is your personal choice. What is important is that you’re covered for top-quality medical services should you ever require it. If you’re interested in finding out more about getting a medical aid plan in South Africa, contact Bloom’s office to make an appointment with a trained consultant and they will discuss the various medical aid plans that are available.


Medical Content Disclaimer

You understand and acknowledge that all users of the Bloom website are responsible for their own medical care, treatment, and oversight. All content provided on the website, is for informational purposes only and does not constitute medical advice. Neither is it intended to be a substitute for an independent professional medical opinion, judgement, diagnosis or treatment.

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Momentum Health4Me is not a medical scheme product, and is not a substitute for medical scheme membership. The information provided on this website does not constitute advice in terms of the Financial Advisory and Intermediary Services Act. Momentum is a division of Momentum Metropolitan Life Limited, an authorised financial services provider (FSP 6406) and a wholly owned subsidiary of Momentum Metropolitan Holdings Limited.

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© Bloom Financial Services 2023. Bloom Financial Services (Pty) Ltd is an authorised financial services provider (FSP 50140). Bloom Gap is underwritten by Infiniti Insurance Limited a licensed non-life insurer and an authorised financial services provider (FSP No.35914)

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