Decision Season for Medical Aid clients

September not only marks the start of spring but also the beginning of a very important decision time for many families.  It is the time when Medical Aids will begin to launch their new product offerings for 2016. All medical aid schemes run in 12-month cycles from January to December. Most medical aid schemes do not allow for the upgrading of a plan during the year. They do however allow for downgrades at any time during the year. If members feel that an upgrade in their plan type is a possibility, this is the time to get information and make that decision as the cut-off date for upgrades is the 11th of December.  After this date, you will no longer be allowed to upgrade until the following year.


Simply put, now is the time to make sure that you and your family are on an optimal medical scheme.  What is the “optimal scheme?” It is the medical aid option  that provides you with  the right amount of cover for you, without having to pay for benefits you aren’t using. Some of the most important personal factors that play a part in choosing the correct scheme for you and your family are:

  • Level and convenience of Hospital Cover
  • Spending on out-of-hospital benefits such as GPs, dentistry, optometry, occupational therapy and prescribed medication
  • Chronic illnesses, treatments and chronic drug formularies
  • Oncology cover and treatment
  • Obviously this is always the ultimate limiting factor.

The level of hospital cover should be the most important item on the agenda, as it is the most costly if not adequately covered. Members must make sure that their hospital cover is unlimited and they need to be aware of the facilities they can make use of.  A great way for budget constrained members to save on premium is to limit  hospital access to your medical scheme’s hospital network.  When doing this one should make sure that the hospital network is accessible and convenient. Health warning. Whilst cost effective, this type of plan will not suit many members who regard personal choice of medical providers and facilities as an important part of their plan.

Out-of-Hospital spending is obviously the most frequently utilized benefit and whilst members can’t know what minor health events might  happen in the year to come, looking at past experience of medical services used will give a general idea of the level of cover required. Medical plans with Medical Savings accounts have become the norm and some have above threshold benefits. However, these plans are becoming ever more expensive.  If you have never made use of the above threshold benefit, it might be beneficial to consider moving to a plan without above threshold benefits or onto a hospital plan and to self-insure for day-to-day spending out of hospital expenditure. Health warning. Decent medical cover doesn’t come cheap and every attempt to reduce premiums will reduce your benefits so be sure to make an informed decision when doing so.

Chronic illnesses are another important factor when selecting an option for the year.  Not only do different medical aids cover chronic medication and treatment differently, but different options within medical aids will also have different levels of chronic cover.  Members must evaluate how the current year’s chronic cover worked for them, and then find out which option will best suit their needs for 2016.

Oncology benefits are provided by all medical aids but are limited/capped when utilizing private healthcare facilities. As this can become an extremely high expense item, we recommend that where possible, members supplement this and other requirements by the addition of an Insurance Gap cover product and by retaining Dread disease/critical illness type cover.


Relevant launch dates currently released are as follows:

Momentum Health     –           21-09-2015

Discovery Health         –           22-09-2015

MediHelp                    –           01-10-2015


Once the 2016 plan types have been announced, we will summarise key points and will provide our clients with the necessary information to aid them in making an informed decision regarding their plan types.

Author: Andrea Lazzari, 08-09-2015