Choosing a Medical Aid Plan in South Africa

October 8, 2016

Medical schemes and their health plans are complicated. Choosing a medical aid plan can be confusing. But it is unavoidable. Before you choose a medical aid plan, you’ll need to evaluate all the options there are.

Does the doctor you’ve seen for the last 30 years have an agreement with your insurer? Costs are lower when you go to an in-network physician. That is because insurance companies contract lower rates with in-network providers and when you venture out of the network, you have to pay out-of-network rates for your treatment. That can be far more expensive than the in-network rates.

Before you choose the best medical aid plan, you need an idea of what your health care costs currently are. We all want to know that if we need to go to the hospital, it will be a private hospital where we’ll get the best care. You need to think of what your medical expenses are. For instance, how much did you spend on day-to-day medical expenses last year? If you find that you’re seldom sick, you may even want to look at a hospital plan.

Choosing a Medical Aid Plan in South Africa


Who Gives the Best Deal?

When choosing a medical aid plan, you need to know what your medical aid scheme will pay for a procedure. Some plans say they’ll pay 100% of the medical aid tariff rate. That by no means indicates that the medical aid will pay your health bill in full. If your treatment costs R10 000, then a plan that offers 100% of the tariff rate means that they’ll be able to pay R5 000 towards the treatment, and you will have to pay the other R5 000 from your pocket. Can you afford it?

When comparing medical scheme plans, look at the summary of benefits. Hippo is a popular comparison website where you can compare prices and benefits and make an informed choice. View your plan options side by side and choose the one you think is best for your family’s needs.

When comparing different plans, think about your family’s medical needs. One of your family may be seeing a specialist every two months, another might have a chronic condition, another may require expensive medications or there may even be a baby on the way.

When Choosing a Medical Aid Plan

  • Be sure to check the scheme’s payment record. Imagine putting in a claim for R50 000 and finding that the medical scheme can’t pay you.
  • Check the institution’s solvency ratio.
  • Check their financial standing. Medical aid schemes need to have at least 25% of members’ annual contributions in reserve.
  • Have a good look at their benefits – what the day-to-day limits are and how much your Savings Account is per year. Do they cover cancer and what percentage of the medical fund rate do they pay?
  • Go with a medical aid that has been in the industry for many years such as Selfmed, who started out way back in 1965.
  • Go with the one who doesn’t offer all those unnecessary add-ons like other medicals aids. You just want medical aid, not shopping rewards and free gym membership.



Why not get in touch with Selfmed today and see for yourself what makes Selfmed stand out from other medical schemes? They offer plain, affordable medical aid. They’re standing by to provide you with a medical aid plan tailored to your unique needs.


All info was correct at time of publishing