Making an informed choice when choosing your medical aid remains critical during a new world order.

Making an informed choice when choosing your medical aid remains critical during a new world order, writes Damian McHugh


The devastating impact of COVID-19 across the globe, as medical personnel and facilities battled to provide the best care under the most difficult conditions, has underscored that medical aid membership is not an optional “nice to have”. The slow pace towards the finalisation and implementation of the proposed government’s National Health Insurance means that for the foreseeable future, individual South Africans will continue to have to make important decisions and choices about medical aid cover to access quality healthcare.


While there is a vast array of options, medical scheme plans can be confusing. Different schemes offer a wide range of packages, which makes it important for each individual to understand the implications of their choices, depending on personal circumstances. After all, anybody can be confronted by a medical emergency at any time and it is not always possible to be prepared emotionally and most importantly, financially. For a variety of reasons, state institutions are often not resourced adequately, hence the need for medical aid cover to meet the costs of medicine, treatments and hospitalisation in the private sector.


The importance of making an informed choice when deciding on medical aid membership cannot be over-emphasised. Cost is always a factor, but ultimately there is no price too high to pay for the best healthcare when the need arises, often during awkward moments financially. An important principle is to understand your needs in order to choose the best out of a number of options on offer. It is often recommended to become a medical aid member at a younger age before the onset of many medical conditions that develop as we grow older. A person in his early twenties without chronic illnesses is not likely to need comprehensive cover, but should most certainly provide for good healthcare for emergencies such as a motor vehicle accident or a broken leg resulting from a football game.


That is why it is important for one to be advised appropriately regarding the implications of opting for a hospital plan against full cover, for instance. Different circumstances suit people differently, and every effort should be made to understand the full extent of benefits in order to avoid misunderstandings and disappointment, especially during critical moments when the best healthcare is presumed to be available. How often have we heard of disputes when members discovered that their medical aid options did not provide for them to undergo certain life-changing surgical procedures which end up having to be funded separately at great unforeseen costs? There is also sometimes confusion about annual hospital limits and how one can best utilise savings funds where they are on offer.


Best medical aid cover should also make provision for a measure of flexibility as a member’s circumstances change. For instance, their marital status and the birth of children that need to be accommodated as well. Some schemes offer better packages than others for families and spouses.


As is the nature of any industry, there is great rivalry and competition among medical aid schemes. That is why it is often recommended to obtain independent advice from an adviser, who is best placed to conduct a full needs analysis and based on that make suggestion on the most appropriate options.


Much of the information about the performance of medical aid schemes is in the public domain, and one can often get a sense of the members’ levels of satisfaction or frustration.

The industry is regulated under South African laws, but that does not guarantee that all medical aid schemes provide optimal service and best value for members’ monthly contributions.


The advent of COVID-19 and the resulting lockdowns have also given fresh impetus for us all to take better care of our health as we examine or review our medical aid membership options. The restrictions on movement and the new phenomenon of working from home have inevitably contributed to much more sedentary lifestyles. Health professionals have for many decades warned us of increased lifestyle disorders arising from a lack of adequate exercise to the extent that even younger people are developing medical conditions that were previously largely associated with advanced age, for instance heart and lung ailments as well as stroke.


This also serves to highlight the importance of understanding one’s own health circumstances in order to invest wisely in a medical scheme that will address specific needs and circumstances in a world coming to terms with the challenges of the pandemic and its many variants.



About the Author

Damian McHugh is an Executive at Momentum Health Solutions.


Published: : 20 June 2022