Choosing between different options within a specific medical scheme will depend on your needs. Most schemes offer a full comprehensive option (hospital costs and out-of-hospital benefits) or a basic hospital plan (cover only for hospital procedures).

Some schemes limit you to a particular hospital group or manage care facilities, depending on the option you choose.

The more limited the option you choose, the less your monthly contribution will be, but make sure you investigate all options. Best advice again is to contact an independent healthcare consultant (broker).

What should a medical scheme pay for?

In 2004 the Medical Schemes Act of 131 of 1998 introduced Prescribed Minimum Benefits (PMB), which is a set of defined benefits to ensure that all medical scheme members have access to certain minimum health services, regardless of the benefit option they have selected. The aim is to provide people with continuous care to improve their health and to make healthcare more affordable.

PMBs determine that medical schemes have to cover the costs related to the diagnosis, treatment and care of certain medical conditions. (Under which a set of 271 medical conditions and the basic 26 chronic disease list are included).

What are my rights according to the law?

The Medical Schemes Act (No 131 of 1998) came into effect on 1 January 2001. It offers a compulsory minimum package of benefits, ensuring the exclusion of risk rating and discrimination on the basis of health, age, race, gender or medical history.

Where to find assistance in choosing a medical aid?

Click here to complete a form to get comparative quotes from leading medical aid providers.