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It’s the time of year when medical aid memberships are up for renewal. Here’s our quick guide to the different types of medical aids available and what they cost.
The two types of medical aids
Medical aids can be split into two types of plans: comprehensive plans and hospital medical aid plans.
Comprehensive medical aid plans
A comprehensive plan covers in-hospital costs and out of hospital costs including day-to-day care such as preventative care and GP visits, usually within certain limits and up to certain amounts. Comprehensive plans are also required to cover standard treatment costs for PMBs, (prescribed minimum benefits) a list of chronic conditions and illnesses such as diabetes, asthma and some cancers.
Comprehensive plans have various options that include:
- Top of the range or executive plans that cover most medical expenses with few limits and co-payments (the share you pay for a procedure, such as the first R3 500 of the cost of a scope) and a choice of providers.
- Full comprehensive plans that cover most medical expenses and day-to-day expenses from a medical savings account. If medical savings are used up, some plans will cover some medical costs under certain conditions, for example they will cover the costs of two visits to a network GP.
- Saver comprehensive plans that cover medical expenses up to certain limits and day-to-day expenses from a medical savings account. There are a number of these in the market and monthly contributions and benefits vary widely.
- Network options that cover most healthcare expenses if a designated service provider (DSP), such as a particular GP, specialist or hospital, is used.
- Income band options that cover some healthcare costs usually at designated services providers, where your contribution is determined by your income.
Hospital medical aid plans
These cover costs for in-hospital healthcare expenses and some preventative care, along with PMBs, which all medical aids must cover. Day-to-day healthcare costs are paid for from your own pocket. Different kinds of hospital plans are available, including network options and income band options. There are also options for students, with low monthly contributions. Some hospital plans will offer limited preventative care such as screening for high blood pressure and diabetes.
2021 medical aid costs
We selected a plan from each of the largest open medical aids and looked at what each one covers, and what it costs for a family of four. These examples give you an indication of what you can expect to pay for different plans and options. You can get a full list of medical aids from the Council for Medical Schemes and details of their 2021 plans on their websites.
| Type of medical aid plan | Plan option | Medical costs this option covers | How much you will pay for a family of four, 2 adults and 2 children per month |
|---|---|---|---|
| Comprehensive | Executive/top of the range | Hospital Rehabilitation Major illnesses and chronic conditions Emergencies Preventative care Maternity and childcare Day-to-day costs |
R18 131 on Bonitas’ BonComprehensive Plan |
| Comprehensive | Full comprehensive | Hospital Rehabilitation Major illnesses and chronic conditions (with limits) Emergencies Preventative care Maternity and childcare Day-to-day from medical savings and options when savings are used up |
R15 174 on Health Squared’s Millennium plan |
| Comprehensive | Saver comprehensive | Hospital Rehabilitation (with limits) Major illnesses and chronic conditions (with limits) Emergencies Preventative care Maternity and childcare Day-to-day from medical savings only |
R8 522* on Discovery’s Classic Saver |
| Comprehensive | Network option | Hospital at DSP** Rehabilitation (with limits) at DSP Major illnesses and chronic conditions (with limits) at DSP Emergencies Preventative care Maternity and childcare Day-to-day from medical savings only or at DSP |
R6 970 on Bestmed’s Beat 3 |
| Comprehensive | Income Band option | Hospital at DSP Rehabilitation (with limits) at DSP Major illnesses and chronic conditions (with limits) at DSP Emergencies Preventative care Maternity and child care Day-to-day at DSP |
R6 104 on Momentum’s Ingwe option (Ingwe network) for an income of R14 501+ |
| Hospital plan | Network | Hospital at DSP Major illnesses and chronic conditions for PMBs only at DSP Emergencies Preventative care Maternity and childcare Day-to-day - option to add savings to the plan |
R3 365 on Fedhealth’s FlexiFed 1 Elect |
*Discovery will not increase medical aid contribution rates for the first six months of 2021, they will review these in 2021 and on 1 July may apply increases that will not be greater than 5.9%
** DSP is a designated service provider that your medical aid has an agreement with. If you use a non-DSP, you will have to pay some or all of the cost
Final thoughts
There are a lot of things to consider when deciding what medical aid best suits your family, but the two most important are your healthcare needs and budget. Take some time to think about what you need from a medical aid and ask for explanations of anything you don’t understand to make your choice easier.
