How medical aids work

A brief introduction to how medical aids work, the different types of plans, and their obligation to cover out-of-hospital expenses for certain conditions, regardless of plan type.
Affordable Medical Aid

Affordable Medical Aid – yes, it DOES exist!

Affordable medical aid for everyone There are plenty of affordable medical aid plans in South Africa. Did you know that you can get a Momentum plan for R370 per month? Granted, most of these "under R1000" plans are income based, which means that you can only join them if the main...

Will I have to pay a Late Joiner Penalty?

The Late Joiner Penalty is paid by medical aid members who are 35yr+ and who have not always had medical aid. Find out how the LJP is calculated, and whether it applies to you or not.
medical aid brokers

Do I need a medical aid broker?

"Do I need to hire a medical aid broker to sign up with a scheme?" No, you can apply to become a member of any medical aid directly to the scheme. Some schemes don't work with medical aid brokers at all. How much does a medical aid broker cost? A broker does...

How do I complain about a medical aid issue?

"I have a complaint about how my medical aid handled my claim. What do I do now?" Medical Aid rules and administration is complicated and there is often misunderstanding and disagreement between the scheme administrator and the member. You should know that when a medical aid refuses to pay for...

When can I change my medical aid plan?

Determining when you can change your medical plan depends on whether you want to stay with the same scheme or not.

What are “Waiting periods”?

Waiting periods are imposed by the medical aid scheme on new members, based on their medical history. The waiting periods can also be applied to Prescribed Minimum Benefits (PMBs).

Can I be refused membership of a Medical Aid Scheme?

"Can I be refused membership by a medical aid if I am very sick or very old?" No, you can't! Medical aid schemes are not allowed to decline you coverage for any reason, other than fraud. They are also not allowed to decline continuing cover for any reason, other...

How do I change my medical aid plan?

A quick guide to how you can change your medical aid plan, including the resignation procedure, and things to look out for, such as imposed waiting periods from your new scheme

All the jargon explained

DSP A Designated Service Provider (DSP) is a healthcare provider (doctor, pharmacist, hospital, etc) that is a medical scheme’s first choice when its members need diagnosis, treatment or care for a PMB condition (see below for definition of PMBs). (source: Council for Medical Schemes) Formulary This is a list of approved medicines...

Medical Aid 101

10 REAL ways to save money on your medical aid in 2019

Chances are, you are not happy with the new price of your medical aid for 2019. The good news is that you can change...

PMBs: Mental Conditions

PMB Mental Health conditions These PMB mental conditions must be covered by medical aids without charging the member out-of-pocket expenses, assuming that protocols and DSPs...

List of the 27 CDL (PMB) Chronic conditions

Chronic PMB conditions PMB (Prescribed Minimum Benefits), including chronic PMB conditions, are conditions that any medical aid needs to pay for, regardless of what plan...