Comparing Medical Aids, Hospital Cover & Medical Insurance

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Ever been in an accident, had to undergo an emergency operation or just a regular checkup at the GP, but your savings are depleted? This is the frustrations faced by many South Africans at this time of the year. With exorbitant monthly fees and an annual increase looming, we investigate what you are actually getting for your buck and whether or not you are getting more than you bargained for.

SA’s Highest Ranked Medical Aids And Their Offerings

The latest South Africa Customer Satisfaction Index(SAcsi) results for 2019 have been released and Consulta has named the top five medical aid schemes in the country. The research was conducted among 1 707 members across the five medical schemes. 

The top five schemes are: 

  • Bonitas; 
  • Discovery; 
  • GEMS; 
  • Medihelp; 
  • Momentum. 

Consulta commented on the results by highlighting the ever-growing frustrations facing medical aid customers as their premiums continue rising, while they are not receiving the service and value for money that they signed up for. “Across the board, the industry is struggling to meet the needs of customers in terms of benefit design that meets the needs of customers in a simple and transparent manner”. 

This year’s results prove that a clear winning medical aid scheme was not identified, however, Bonitas and Discovery have come out as leaders in the industry. Medihelp has equalized with the rest of the industry, whilst GEMS and Momentum have both received below par (72,9) responses from the survey. 

One of the main reasons why customers are dissatisfied with their schemes is because their benefits are never clearly outlined to them when they sign on the dotted lines. 

Professor Adré Schreuder, SA-csi founder and chairperson, explains that one of the main reasons for this is that the healthcare providers fail to outline the customer’s benefits adequately. “It is notable that customers complain most often about the detail and performance of their cover, the related fees and costs, additional out-of-pocket co-payments, and for claims not being covered in particular when it comes to chronic medication.”

Are You Getting Your Monies Worth? 

Another issue plaguing the industry is the exorbitant rates that providers are expecting the average South African citizen to fork out each month. 

According to Consulta, thousands of South Africans spend over 20% of their monthly earnings on their medical aid bills, however, many times, they are still expected to pay whopping excesses should they visit specialists. 

Although some medical aid schemes offer their customers additional benefits, such as reduced gym fees, flights, and healthy living, many members are forced to downgrade their packages in order to receive minimal cover in case of emergency or hospitalization. 

Nowadays, having medical aid does not make a difference, as many doctors around the country are no longer being affiliated with medical schemes. This is putting a huge amount of pressure on consumers as they are forced to scrap additional money together, on top of their monthly medical aid fee, just to cover a doctor’s visit. 

Monique, a client of one of the biggest medical aid schemes, recently went for an emergency operation which she was told that she was covered by her medical aid. “I had to be rushed into theatre, and the shock of the unexpected surgery meant that I was not prepared and of the right mind to still have to worry about fitting the bill,” explains Monique. 

Once the procedure had been completed, just a few days later, the surgeon requested that she pay the outstanding bill of R17 000. She was so angry as she was told that her hospital plan covers emergencies within a 24-hour period and that this operation would be covered by her medical aid. 

So What Do Each Of SA’s Biggest Medical Aids Offer? 

Ever really wanted to know whether you are getting value for your money? Well we weighed up the odds of each of the top five medical schemes in the country and here are our findings: 

About the Medical Aids

Many of these names you might have heard or, maybe you are even a member with one of these schemes. We thought we would break down each medical aid provider for you so that it could make your choice even easier. 

Discovery Health

Discovery Health is the biggest scheme in South Africa with over 31% of all beneficiaries signed up with one of their plans. This accounts for more than 2.8 million South Africans using one of their services. 

Discovery, although some of their plans are quite pricey, provide a variety of additional benefits to their members. From Healthy Dining, Vitality, Active Rewards, Drive Well as well as the new Discovery Bank which was launched a few weeks ago, online benefits seems to be the way forward for this medical scheme. Go to website

Bonitas

Bonitas is South Africa’s second largest medical aid scheme catering to over 700 000 people countrywide. This constitutes for over 8% of the market share in the medical aid industry. The great thing about this scheme is that customers receive free delivery of all medications. Families who have more than three children, only pay for the first three, with the rest receiving free medical aid. Go to website

Momentum Health

With just over 200 000 customers and 3.2% of the total market share, Momentum takes the spot for the fifth largest medical aid provider in the country. This scheme offers all their clients preventative and screen tests for early disease detection. 

They also provide their customers with unlimited hospitalization as well as the Momentum Multiply rewards programme which offers a variety of benefits from reduced gym membership to monthly money savings. Go to website

Best Med

Best Med pride themselves on being self-administered which means that “more of your money goes to your benefits and less towards administration”. They have received 2.26% of the total market share. 

They are one of the only medical aid schemes in the country with a ‘no self payment gap’ policy as well as providing a scheme with fewer co-payments. This allows customers to spend less money once they have paid their monthly medical aid bill. Go to website

MediHelp

MediHelp is the eighth largest scheme overall in the country, with 2.25% of the total market share,  and is on par with Best Med as the fifth for the open medical aid division. MediHelp provides their customers with personal medical aid suitable to their needs. From student plans, hospital plans, savings plans and comprehensive plans- there is something to suit every budget. 

MediHelp also provides unlimited hospital cover and all dependants can remain dependants until the age of 26. MediHelp also provides a free online wellness and emergency app which is accessible to all members. Go to website

New Year, New Prices

With the end of 2019 upon us, this means that an annual increase of everything is expected, including medical aid schemes. 

Discovery Health has announced that their customers can expect a 9,5% increase from next year, with Bonitas increasing theirs to a whopping 9,9% and Momentum to 8,2%. 

Many consumers will feel the pinch as this could mean for some, just over R500 extra per month. 

There are however, cheaper offers available to those earning less than R8 500 per month. The table below illustrates the cheaper medical aid options :

Medical Aid SchemeMonthly Medical Aid Price
Discovery KeyCareR914
Momentum IngweR1 062
Profmed SavvyR1 112 
Genesis Private ChoiceR1 150
Bonitas BONCAPR1 159
Fedhealth FlexiR1 611

If you really don’t think you want a medical aid plan, there are also hospital plans available. According to the Medical Aid Comparison website, Discovery Health Essential Smart Plan, Momentum Custom Option and Bonitas’ BonEssential are the top three hospital plans available. 

Here is what you could expect to pay for these three options: 

  • Discovery Health Essential Smart Plan – R1 285 per month
  • Momentum Custom Option – R1 515 per month
  • Bonitas’ BonEssential – R1 731 per month

Another option for medical cover that we have found that many people don’t know about is called Medical Insurance. Medical Insurance is normally a fraction of the price of medical aids with some medical benefits that even certain medical aid schemes don’t cover. They do state that it isn’t a substitute for Medical Aids but it sure seems like they are similar. Why do we always go with the well-known medical options, is it because we don’t know if we can trust other options? “I have been paid out for all my children’s’ hospital bills when my son broke his wrist Affinity health paid for the surgeon and all the expenses, they have even paid my daughter’s dentist expenses as well as medication” Cherie Meyer.

Here are some popular options we have found: 

1. Affinity Health- This medical insurance’s health schemes start from R509 to about R1179 per month. There are benefits on these plans such as day-to-day cover which includes doctors visits and medication, dentistry, radiology as well as hospital coverage. Go to website

2. EssentialMed- This company has medical cover ranging from approx. R351 – R527 . You can also get Day-to-Day cover, as well as Hospital Plans, Accidents and Emergencies Cover and Life and Funeral Cover. Their website states that you can add Hospital cover to other plans for only R54 which also includes ICU and Maternity cover. Go to website

3. Elixi – These plans start from approx. R326 – R665 and Elixi has a range of 4 different plans for different needs from just day-to-day care to primary and hospital cover. The entry-level package offers things such as Unlimited GP visits and pap smears where the top cover, namely the black plan offers a lot such as In-Patient Hospital Treatment and Specialist Visits. Go to website

Although this might all seem a little bit confusing, the best advice would be to choose a package that suits your personal needs. Make sure that you are aware of the charges, payment gaps and shortfalls before signing on the dotted line.

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